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Forms & worksheets.
Everything here prints cleanly on a single sheet or two. Fill them in by hand, bring them to session, or just use them for yourself. Nothing you type on this page is stored or sent anywhere.
Official paperwork. Your informed-consent agreement, privacy notice, telehealth consent and any release-of-information forms are sent to you directly before your first appointment, so that the versions you sign are always the current ones. The intake sheet below is the one it helps to have done in advance.
New patient intake
Dr. Donna Duffin, Psy.D. · Clinical Psychologist
1. What brings you here?
In your own words. A few sentences is plenty.
2. How long has this been going on?
3. Why now — what made this the week you got in touch?
4. Which of these have been present in the last month?
Persistent worry or dread
Low mood most of the day
Loss of interest or pleasure
Panic attacks
Trouble falling or staying asleep
Appetite or weight changes
Irritability or anger
Difficulty concentrating
Withdrawing from people
Physical tension or pain
Grief or a recent loss
Relationship difficulty
Increased alcohol or substance use
Thoughts of self-harm or suicide
If you ticked the last box, please tell Dr. Duffin at the start of your first session. If you are in danger now, call or text 988 rather than waiting.
5. Have you had therapy before?
When, with whom, for what, and what did or did not help?
6. Current medications and supplements
| Medication / supplement | Dose | Since when | Prescribed by |
|---|---|---|---|
7. Medical history worth knowing about
8. Who supports you?
Partner, family, friends, faith community, colleagues — whoever actually turns up.
9. What would “better” look like six months from now?
Be as concrete as you can. What would you be doing that you are not doing now?
10. Anything else you would like Dr. Duffin to know before you meet?
Thought record
The core CBT worksheet. One specific moment per sheet.
1. Situation
Facts only — who, what, where, when.
2. Emotion, and its strength out of 10
3. The hot thought
The exact sentence that went through your mind.
4. Thinking traps present
All-or-nothing
Catastrophising
Mind reading
Fortune telling
Emotional reasoning
Should statements
Labelling
Discounting the positive
Personalisation
Mental filter
5. Evidence for
6. Evidence against
7. A more balanced thought
Accurate, not cheerful. It should feel slightly boring.
8. Emotion strength now, out of 10
Weekly mood & activity log
Mood 1–5. One line a day. Patterns show up in a fortnight.
| Day | Mood | Sleep (hrs) | Movement | What happened / what I noticed |
|---|---|---|---|---|
| Monday | ||||
| Tuesday | ||||
| Wednesday | ||||
| Thursday | ||||
| Friday | ||||
| Saturday | ||||
| Sunday |
The best hour of the week, and what was happening in it
The hardest hour, and what was happening in it
Worry window sheet
Fifteen minutes, same time each day, never right before bed.
| The worry | Can I act on it? | If yes: the single next step. If no: what I am letting be. |
|---|---|---|
| Yes / No | ||
| Yes / No | ||
| Yes / No | ||
| Yes / No | ||
| Yes / No | ||
| Yes / No |
A worry that cannot be acted on is not a problem to be solved. It is a feeling to be tolerated — and tolerating it is a skill that improves with practice.
Between-session practice log
The hour in session matters less than the week around it.
What I agreed to try this week
| Day | Did it? | How hard was it (0–10) | What I noticed |
|---|---|---|---|
| Mon | |||
| Tue | |||
| Wed | |||
| Thu | |||
| Fri | |||
| Sat | |||
| Sun |
What got in the way
This is the most useful box on the page. Obstacles are material, not failure.
Session preparation sheet
Five minutes before your appointment. It reliably makes the fifty minutes go further.
If we only get to one thing today, it should be…
What has changed since last time — better or worse
Anything I have been avoiding mentioning
Writing it here makes it much likelier to be said out loud.
A question I want to ask
Something that went well, however small
Guided practice scripts
The six practices from the videos page, written out so you can follow them on paper.
Three-minute breathing space
- Sit up, feet on the floor, eyes closed or resting on one spot.
- Wide: what thoughts are here? What feelings? What is the body doing? Name each plainly, including the unwelcome ones.
- Narrow: bring all of it down to a single point — the breath. One full breath in, one full breath out. Then the next.
- Wide again: the breath, and the whole body around it. Posture, face, the room. Carry a little of that attention into what comes next.
Ten-minute body scan
Move attention slowly through: both feet → lower legs → knees and thighs → hips and lower back → stomach → chest and upper back → hands → arms and shoulders → neck and jaw → face and scalp → the whole body at once. At each place, notice what is there — warmth, pressure, tingling, or nothing. You are not trying to relax; you are only noticing. When your mind wanders, that is the practice working, not failing.
Sleep wind-down
Do not try to fall asleep — aim only for rest. Let the bed take your weight. Breathe in for four, out for six, and keep the exhale unhurried. Label any thought about tomorrow “planning” and set it down. Then picture yourself slowly walking down a long hallway where nothing happens. If you are still awake after twenty minutes, get up and sit somewhere dim until you feel sleepy.
Self-compassion break
Bring one specific difficult moment to mind and notice where you feel it. Then three sentences: “This is hard right now.” — “Difficulty is part of being a person.” — “May I be kind to myself,” or “What would I say to a friend here?” Say the third in the tone you would actually use with them. Awkwardness is common and is not a problem.
Two-minute morning anchor
Sit on the edge of the bed, feet on the floor, before the phone. Three slower breaths. Then: what does today actually ask of me — one sentence, not a list? What would I like more of today — patience, focus, warmth, rest? What is the first small thing? Stand up and begin.
Urge surfing
Notice the urge without obeying or fighting it. Locate it in the body and rate it out of ten. Breathe into that area and let it be exactly as strong as it is. Urges are waves: this one is rising and it will crest — most peak within twenty minutes. Rate it again. Whatever you decide next, you are deciding it rather than being pulled.
Print settings
For the cleanest result, choose Portrait, margins Default, and switch off “headers and footers” in your browser’s print dialogue. Background colours are not needed — every form is designed to print in black and white.