Personal and Relationship Checklist
Contact Information
Town & Country Psychotherapy
With the current COVID-19 issues we are offering teletherapy by phone or video. Outdoor therapy may be available.
Location:
Fair Oaks, CA 95628
Phone:
916-966-2209
Business Hours:
Monday-Thursday: By appointment only
Personal and Relationship Checklist
We invite you to use this checklist as a tool in assessing your needs. These items are symptoms of problems you may need help in dealing with...please seriously consider seeking solutions. If we may be of help to you or someone you know please call 916-966-2209.
Family
“Our family has...”
communication problems
irresponsible or destructive behavior
uncontrolled conflict or physical abuse
loss of trust and respect
social or academic difficulties
apathy or chronic health problems
Marital
“Our relationship has...”
a problem with communication
nagging or jealousy
uncontrolled conflict or physical abuse
intimacy or sexual problems
chronic disagreements about parenting
excessive absence from home
conflict over money, religion...
Personal
“I am...”
feeling tense, nervous or worried often
having difficulty with sleep or weight change
wanting medication or alcohol to help me cope
chronically feeling guilty, blamed or worthless
having difficulty concentrating or “thinking too much”
frightened or worried about what I am thinking or feeling
having difficulty in my relationships with others
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