DSM-5 Level 1 Cross-Cutting Symptom Measure—Adult 

If you have any issues filling out this intake please call the Brownsville Counseling and Training Clinic at (956) 882 - 7792 or the Edinburg Counseling and Training Clinic at (956) 665 - 5251.

Sex

Instructions: The questions below ask about things that might have bothered you. For each question, circle the number that best describes how much (or how often) you have been bothered by each problem during the past TWO (2) WEEKS

Depression
Anxiety
Other
Behavior
Stability
Using any of the following medicines ON YOUR OWN, that is, without a doctor’s prescription, in greater amounts or longer than prescribed