SUITABILITY ASSESSMENT FOR LINDEN ANXIETY RECOVERY

  • GUIDANCE ON COMPLETING THIS FORM

    Please fill in the form to the best of your ability and click submit. This form will be sent directly to a Linden Method Specialist. All information is treated in the strictest of confidence and not passed to any third parties outside of our organisation.

    If you are unsure whether our anxiety recovery program is suitable for you, please complete the form below and we will be back in touch to advise.

    All Information is stored confidentially and in line with GDPR guidelines. All employees of The Linden Method abide by our Code of Ethics, for a copy of this or if you have any concerns or questions relating to policies, please email admin@thelindencentre.org
  • Yes No
    Have you been diagnosed with anxiety disorder?
    Have you ever been diagnosed with clinical depression?
    Are you currently taking prescription medication for your anxiety disorder?
    Have you ever had Cognitive Therapy? (CBT)
    Are you receiving regular visits from Mental Health Services?
    Have you received other talking therapy?
    Have you ever been hospitalized for your condition?
    Do you have any disabilities or medical conditions?

  • Your symptoms

    Please be as honest as you can with your answers - This information will not be divulged to a third party. All of the symptoms and manifestations listed below are very common when you have an anxiety disorder but this list is by no means exhaustive. There are many others but that's not to say they don't exist within the realms of an anxiety disorder. This program is SOLUTION FOCUSED and treats the underlying anxiety and not the symptoms.
  • YES
    Generalized Anxiety Disorder
    Panic Attacks
    Agoraphobia (not wanting to leave your perceived place of safety)
    Monophobia (fear of being left alone)
    OCD
    Pure O (Disturbing Thoughts)
    Post Traumatic Stress Disorder
    Emetophobia
    Obsessive focus surrounding food
    Social Anxiety Disorder
    Derealisation
    Depersonalisation
    Insomnia
    Social Anxiety
    Health Anxiety
    PTSD|
  • YES
    Palpitations
    Tightness in Chest
    Racing heart
    Dizziness/Feeling Faint
    Headaches/Feeling like a band is around your head
    Numbness, tingling in head
    Tension/Pain in back, neck and shoulders
    Chronic Fatigue
    Heaviness/tingling in limbs/muscle pain
    Smothering sensation/inability to take a deep breath
    Excessive focus on breathing
    Globus Hystericus (feels like lump/blockage in throat)
    Excessive perspiration
    Skin blanching (paleness) or excessive blushing
    Nausea /sickness
    Acid indigestion / reflux
    Urgency to use the toilet
    Irritable Bowel (IBS) Symptoms/Stomach Issues
  • YES
    Obsessive thoughts
    Aggressive thoughts
    Sexual thoughts
    Religious thoughts
    Anxiety about your health
    Fear of death
    Thoughts about existence
    Compulsive thoughts / rituals
    Suicidal thoughts
    Depressive thoughts
    Confusion
    Low Mood
    Fear of Failure (unable to make decisions)
    Lack confidence/Feeling of not being good enough
    Concerns about being judged by others
    Feeling of guilt about the past
    Loss of feelings of love for others
    Very poor concentration
    Feelings of being unable to cope
    A sense of impending doom
    A sense of living outside of your body
  • If appropriate, please give details of how recent these events happened and if they are likely to be resolved anytime soon.

  • IMPORTANT… please read!

    As with any form of Coaching, your commitment is key. The Linden Method program is SOLUTION FOCUSED. It is NOT about giving you management techniques or coping strategies. It is NOT about talking about your PAST. It is focused on taking you forward from the here and now and not looking and evaluating your past.

    It is NOT what you've tried previously that has failed you. Our program will empower you, the sufferer, to help yourself and guide you towards full recovery. Ultimately, the only person that can fix you, is you! What you haven't appreciated yet is that you have a superpower (yes, you may not be think that right now, but you really do!). You haven't learnt how to harness it and instead of unlocking your brilliance, it is working against you (and providing 'oxygen' for the anxiety!)

    We are often asked:
    But this is my last chance at getting well and what if this doesn't work? What then?"

    OK, so where do you think those "What if?" thoughts are coming from?

    This will work if you engage in it, of that we are sure.

    The Linden Method program will show you how to harness your superpower and empower you to navigate your roadmap to freedom from anxiety.

  •  
    Barely functioning
    1
    2
    3
    4
    5
     
    Coping day to day
  •  
    Not very
    1
    2
    3
    4
    5
    6
    7
    8
    9
    10
     
    100% Committed
  • Name
    Relationship to sufferer
    Mobile number
    Is the sufferer aware you have contacted us