Pre-course Assessment Pre Course Assessment Name(Required) DrMissMrMrsMsProf.Rev. Prefix First Last Age(Required)Email(Required) Enter Email Confirm Email Phone(Required)When is the start date for your course(Required) How did you hear about us?(Required) Which course are you attending?(Required) Initial Assessment Online Group Course In Person Group Course Individual (one 2 one) Course Do you have any children?(Required) Yes No Do you work...(Required) Part time Full time Volunteer Retired Unemployed What is your occupation? Do you find it stressful?(Required) Yes No How well do you manage your stress(Required) Badly Could be better Neither good or bad Pretty good Excellent Have you ever been in therapy?(Required) Group Therapy One to one Both No What kind of therapy?(Required) Ever done an anger management course or one to one work before?*(Required) Yes No Do you have any addictions, such as alcohol, nicotine, drugs?*(Required) Yes No Please give details about your addictions – does this enhance your anger?(Required)Do you drink?(Required) Yes No How much do you drink weekly? (Units)(Required) Do you get angry when drunk?(Required) Yes No Are you taking any prescribed medication?(Required) Yes No Please state which medication you are on and your dosage etc(Required) Have you been physically violent in the past 3 years?(Required) Yes No Please give incidents, against whom, frequency etc*(Required)Were you ever bullied(Required) Yes No Where were you bullied?(Required) Did you go on to bully?(Required) Yes No Did you go to boarding school?(Required) Yes No From what age to what age(Required) Are you currently in the armed forces or have ever been?(Required) Yes No Did either of your parents or any other relatives ever serve in the military?(Required) Yes No Do you or any of your relatives work in the police services?(Required) Yes No Did either of your parents or relatives work in education?(Required) Yes No Do you come from a religious background?(Required) Yes No How does anger affect your life?(Required)Where do you get most angry?(Required) Home Work Both In the community When tired, do you get irate and grumpy?(Required) Yes No Do you get angry when you feel attacked or criticized?(Required) Yes No Sometimes Do you have any emotional support?(Required) Yes No Sometimes Who makes you most angry?(Required)After getting very angry, what is the first thing you tend to do?(Required)How do you know when you're angry?(Required)What do you experience when someone is angry with you?(Required)Who were your role models for expressing anger?(Required) In what way did your father express his anger?(Required)In what way did your mother express her anger?(Required)In what way did your siblings express anger?(Required)What was the effect of your own anger within your family?(Required)What is it about your anger that you fear most?(Required)What is it about your anger that you most appreciate and respect?(Required)What are your expectations, what do you want to achieve from this course?(Required)Is there anything you would like to add or bring into the course discussion?(Required)Consent(Required) I agree to the Privacy Policy & Terms of Service.Your information will never be shared with third party companies and will always remain confidential. Δ
