Waji Treatment Fit Questionnaire

INSTRUCTIONS:

Please read all instructions carefully and answer the questions as accurately as possible. There are no right or wrong answers, just select the answer that best applies to your lived experiences.

First Name
Email
Mobile Number
The following questions will ask you to identify and provide basic details regarding events you may have experienced that were stressful or traumatic.

❗❗ IMPORTANT ❗❗ - WHAT IS A SINGLE TRAUMA VS MULTIPLE TRAUMAS? PLEASE READ THE EXPLANATION CAREFULLY:

How should you determine the number of traumas you have suffered?
Some traumas are isolated events, like a car accident or the loss of a loved one. For some, you have to use your intuition as to how to differentiate between traumas if necessary. In implementing our therapy we have found that even though one person may have hurt someone many times in the past, our brains tend to generalize the events into one basic trauma. So please count abuse from each person as one separate trauma. You may count multiple events from one time or place in your life if they seem to group together in your imagination. Just go with what you feel. 


Have you experienced more than one traumatic event?

Which type of difficult or stressful event(s) did you experience?

At what age did the/these event(s) occur?

What was the longest amount of time you were exposed to a single stressful event?

13. Trouble falling or staying asleep?
14. Irritable behavior, angry outbursts, or acting aggressively?
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