This questionnaire assesses for violent thoughts & tendencies.

Do you argue with others frequently, use profanity, speak in a loud or very soft voice, make verbal threats to do harm to yourself or others, and/or have an aggressive stance?
Are you hyperactive (such as finger drumming, pacing, staring, wringing your hands) and/or experience increased/uncontrolled pain?
Do you experience active paranoid delusions, hallucination with negative effect (such as command hallucinations), a manic state, and/or have stopped taking psychiatric medications without prior consultation?
Do you have a history of mental illness, violence toward self or others, and/or substance abuse?
Do you excessively use alcohol or drugs and experience withdrawals?
Do you have dementia with behavioral disturbance and/or delirium?
Do you carry a weapon or any object for weapon use?
Have you experienced a recent separation, divorce, death of parent/spouse/child, loss of job, friend or pet?

Please fill out all required fields and click the "Submit" button at the end of the questionnaire. 

Following completion, an email will be sent to you with results and how to follow up.

© 2018 Refined Transitions

Please call during our hours of contact to schedule an appointment. If you call after hours, we will return your phone call during our hours of contact.

Monday - Friday

8:00am - 4:00pm


4445 Eastgate Mall Rd #200

San Diego, CA 92121