Starfield:Psych Eval: Andres Jensen

Please answer questions as honestly and completely as possible. --

1. Have you had any recent changes to your medical history?

2. On a scale of 1 to 10, how would you rate your current job satisfaction?

3. Have you at any time in the last 3 months experienced periods of abnormal anxiety, anger, sleeplessness, and/or irritability?

4. Have you had any thoughts of harming yourself or others?

5. How would you describe your current work/life balance?

6. Do you have any unusual concerns about your coworkers?