Initial Consultation Questionnaire (Long Version)
Initial Consultation Questionnaire (Long Version)

QPC-L

Initial Consultation Questionnaire (Long Version)

This intake questionnaire collects the essential information before a first consultation. It helps identify the patient's main presenting problem, the context in which it arose, its impact on daily life, and their expectations regarding the support provided. A practical tool for preparing the first sessions effectively and having an overview from the very start of treatment.

Number of questions
16 questions
Estimated duration
4 minutes
Language
English
Original name
Initial Consultation Questionnaire (Long Version)

Preview of the 16 questions

Scoring & interpretation

Summary

The responses highlight a history marked by contexts of great emotional insecurity and repeated relational experiences of abandonment, which may have a lasting impact on self-confidence and emotional stability. There is a pervasive sense of loneliness, a tendency toward psychological exhaustion, and a persistent difficulty in engaging in relationships experienced as secure. Mood fluctuations and memory and attention problems are reported, along with a sense of existential devaluation, with no reported suicidal ideation but with feelings of emptiness and disorientation. Overall, this suggests a complex situation to be monitored closely, particularly with regard to self-esteem and coping capacities.

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