Denial Test Form

Denial Test Form

This form is to help determine how much denial you are experiencing
Do you have a problem?

Other
Do you ever experience anger, anxiety or depression?

Other
Do you have more than one problem?

Other
Does your main problem involve other people?

Other
Do other people think you have a problem?

Other
If other people think you have a problem, what do they say to you?

Other
Do other people have a problem?
Is there someone who to blame for your problem?

Other
Are the problems you experience always someone else's fault?
Have you tried everything you can think of to fix your problem?
Do you need to do something about your problem?
Are you willing to do something about your problem?
Select all of the things that you are willing to do about your problem?
Please describe your problem (s).
If this is an old issue, explain the first time it happened.
Who are you willing to speak with? (if other, please add their name and email address)

Other
Name

First NameLast Name
Email
example@example.com
By submitting I hereby confirm that the information I have given above is true, and that I will be receiving an email response to my submission and an invitation to discuss the results with a nonprofessional member of Mixed Recovery.
Signature
Should be Empty: