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Exit Survey
 
 
Thank you for taking the time to complete our Background Questionnaire for adult psychology services offered at Fundamental Therapy Solutions. This questionnaire will help us to find the right treatment for you and will save time in gathering important information. Please provide as much accurate information as possible to help us understand your needs.

We understand that everyone is unique - if a question is difficult to answer because of your unique circumstances, that's okay. Your therapist will be talking with you to fully understand your circumstances and history. Please answer these questions to the best of your ability anyway.

This questionnaire will take approximately 30 minutes to complete (Note: our site is having difficulty saving incomplete surveys, please fill out this survey when you have time to finish it in full without interruption or drop in internet connection). If you feel uncomfortable answering any questions, you can skip any question or stop the questionnaire at any point. Your responses will be strictly confidential and this online version complies with all HIPAA requirements for privacy and confidentiality. You may request to complete our paper-and-pencil questionnaire at our office instead of completing this online version. If you have questions about the questionnaire, you may contact Fundamental Therapy Solutions at 352-505-6363 or by email at [email protected]

Thank you for completing this questionnaire. Please start by clicking on the Continue button below.