COUNSELOR PREPARATION FORM
Patricia Hare Pizer, M.ED, LMFT, LPC Appt. Date: _____________________________
Louisiana Telemental Health Appt. Time: _____________________________
For Appointments Call 225-767-1165 Patient Portal Access Code: ______________________________
Questions:
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Session Notes:
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Patricia Hare Pizer, M.ED, LMFT, LPC Appt. Date: _____________________________
Louisiana Telemental Health Appt. Time: _____________________________
For Appointments Call 225-767-1165 Patient Portal Access Code: ______________________________
Questions:
1. ________________________________________________________________________________________________________
2. ________________________________________________________________________________________________________
3. ________________________________________________________________________________________________________
4. ________________________________________________________________________________________________________
5. ________________________________________________________________________________________________________
6. ________________________________________________________________________________________________________
7. ________________________________________________________________________________________________________
8. ________________________________________________________________________________________________________
Session Notes:
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
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Symptoms of Depression:
- Frequent crying and bouts of sadness
- Feeling hopeless or worthless
- Getting too much or too little sleep
- Difficulty enjoying activities one used to like
- Unexplained headaches or muscle pain
- Changes in weight or eating habits
- Difficulty concentrating
- Thoughts of suicide
- Anxiety
- Anger
Symptoms of Panic Disorder:
- Racing heartbeat
- Strong feelings of impending doom
- Dyspnea (feeling like you can’t get enough air)
- Excessive perspiration or overheating
- Numbness or tingling or Trembling
- Chills, Nausea or Chest Pain
- Faintness, dizziness