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Have you been to Therapy before? *

If yes, tell us what made you stop therapy previously. *

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"1" for poor and "10" for Good

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Are you currently experiencing any chronic pain? *

If yes, where do you feel the pain? *

When was the last time you thought about Suicide? *

Are you currently taking any medications? *

If yes, please mention the names of the medicines that you are currently taking. *

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