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Social Anxiety Disorder
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Home
About
Specialties
ADD/ADHD Adolescent and Adult Counseling, Therapy, Individual Coaching, Couples Counseling
Anxiety and Stress
Generalized Anxiety
Panic Attacks and Phobias
PTSD
Social Anxiety Disorder
Neurological Disorders
Couples and Family Counseling
Acute Stress, Trauma
ADHD Assessments, ADHD Therapy, ADHD Coaching
Brain Injury TBI
Therapy for Depression
Executive Services
Therapies
Telehealth
Couples and Family Counseling
Individual
Cognitive Behavior Therapy
Emotion-Focused Therapy
Foundational Therapies
Hypnosis
Individual IBS Therapy
Mindfulness-Based Therapy (MBCT)- Harnessing Positive Energy
Cognitive Rehabilitation
Biofeedback
Group
IBS Stress Group
Resources
Blog
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Home
About
Specialties
ADD/ADHD Adolescent and Adult Counseling, Therapy, Individual Coaching, Couples Counseling
Anxiety and Stress
Generalized Anxiety
Panic Attacks and Phobias
PTSD
Social Anxiety Disorder
Neurological Disorders
Couples and Family Counseling
Acute Stress, Trauma
ADHD Assessments, ADHD Therapy, ADHD Coaching
Brain Injury TBI
Therapy for Depression
Executive Services
Therapies
Telehealth
Couples and Family Counseling
Individual
Cognitive Behavior Therapy
Emotion-Focused Therapy
Foundational Therapies
Hypnosis
Individual IBS Therapy
Mindfulness-Based Therapy (MBCT)- Harnessing Positive Energy
Cognitive Rehabilitation
Biofeedback
Group
IBS Stress Group
Resources
Blog
roger@doctorlavine.com
|
(954) 716-6702
BAARS IV Self Report – Quick screen
Step
1
of
3
33%
General Information
Your Full Name
First
Last
Sex
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Female
Date of Birth
*
MM slash DD slash YYYY
Email
Phone
SECTION 1
CURRENT SYMPTOMS
For the next 5 questions, please select the option that best describes your behavior
DURING THE PAST 6 MONTHS.
Hidden
Start section 1
1. Fail to give close attention to details or make careless mistakes in my work or other activities.
*
Never or Rarely
Sometimes
Often
Very Often
Question 1
Q1 is a symptom
2. Have difficulty organizing tasks and activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 2
Q2 is a symptom
3. Avoid, dislike, or am reluctant to engage in tasks that require sustained mental effort
*
Never or Rarely
Sometimes
Often
Very Often
Question 3
Q3 is a symptom
4. Lose things necessary for tasks or activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 4
Q4 is a symptom
5. Easily distracted by extraneous stimuli or irrelevant thoughts
*
Never or Rarely
Sometimes
Often
Very Often
Question 5
Q5 is a symptom
Section 1 is almost completed
Please answer the following question(s) to complete section 1
6. Did you experience any of these five symptoms at least "often" or more frequently (did you circle 3 or 4 above)?
*
Yes
No
Great job! You've completed section 1.
Please click the next button to continue with section 2
7. How old were you when these symptoms began?
*
8. In which of these settings did those symptoms impair your functioning? Please a checkmark next to all the areas that apply to you.
*
School
Home
Work
Social Relationship
Great job! You've completed section 1.
Please click the next button to continue with section 2
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Score Section 1
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Total Score Section 1
Hidden
Total symptoms section 1
SECTION 2
CHILDHOOD SYMPTOMS
For the next 5 questions, please select the option that best describes your behavior
BETWEEN 5 AND 12 YEARS OF AGE.
Hidden
Start Section 2
1. Didn't follow through on instructions and failed to finish work or chores
*
Never or Rarely
Sometimes
Often
Very Often
Question 1
Q1 is a symptom
2. Had difficulty organizing tasks and activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 2
Q2 is a symptom
3. Lost things necessary for tasks or activities
*
Never or Rarely
Sometimes
Often
Very Often
Question 3
Q3 is a symptom
4. Was easily distracted by extraneous stimuli or irrelevant thoughts
*
Never or Rarely
Sometimes
Often
Very Often
Question 4
Q4 is a symptom
Section 2 is almost completed
Please answer the following question(s) to complete section 2
5. Did you experience any of these four symptoms at least "often" or more frequently (did you circle 3 or 4 above)?
*
Yes
No
6. In which of these settings did those symptoms impair your functioning? Please a checkmark next to all the areas that apply to you.
*
School
Home
Social Relationship
Great, you've made it.
Just click the submit button below to send the results to dr Lavine and he will reach out to you shortly.
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Score Section 2
Hidden
Total score Section 2
Hidden
Total Symptoms Section 2
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Total Score for entire form
Result
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Total score form
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Total Symptoms form
Phone
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Δ
2881 East Oakland Park Blvd.
Fort Lauderdale, FL 33306
roger@doctorlavine.com
(954) 716-6702
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