CALL NOW 602-478-1477
(F) 602-773-0998
RISA E. NEWELL, Ph.D., L.L.C.
LICENSED CLINICAL PSYCHOLOGIST
Patient Evaluation - VIEWING and PRINT
Risa Newell, Ph.D., L.L.C., Licensed Clinical Psychologist
7047 E. Greenway Parkway, #250 | Scottsdale, AZ 85254
(T) 602-478-1477 (F) 602-773-0998 risa@newellphd.com
Newellphd.com
Thank you for taking the time to complete this evaluation – a thorough review of important parts of your life. The following questions are personal and sensitive in nature and will remain strictly confidential and secure. By completing this form, you will provide valuable information for the therapeutic process.
You may also just bring this form with you to your Initial Evaluation appointment.
Identifying Information
January 26, 2026
Submitted
Melissa Sawyer
* Required
02 05 1965
Partner/Spouse
Married
Michael Sawyet
08 16 1964
Megan: 30
Mitchell: 24
Baxter
2 sisters, mother
true
Special Education Teachet
Paradise Valley Unified School District
Megan Sawyer
Daughter
6025013030
Current Concerns
What are you most concerned about now?
Family relations
Depression
Anxiety
Please rate your current level of distress, from 1-10, (1=minimal to 10=extreme):
8
When do you tend to feel the worst?
All day
Please indicate how long you’ve been feeling this way now:
8 days
Have you ever felt this way in the past?
Yes
If so, when and how severe?
I have had these issues for close to 40 years. The level of severity just changes.
What has been done so far to address these concerns?
I am on depression medication and have been in therapy many times throughout these years.
Do you have any negative beliefs about yourself?
Yes
If yes, what are they?
That I am a failure as a mother to my son. That I have no idea how to be a happy person, a rarely feel joy. That I have no purpose. That I am an emotional burden to my daughter.
Specify which areas of your life are affected by this problem:
Physical, Home, Family, Relationships
Other?
Stressful Life Events
Please indicate if any of the following have occurred within the past 12 months:
Serious Problem with Child
Marriage
Financial Stress, Work Stress
Other:
Psychiatric Symptoms: DSM-5 Self-Rated Measures - Adult
Instructions: The questions below ask about things that might have bothered you. For each question, select the frequency that best describes how much (or how often) you have been bothered by each problem during the past TWO (2) WEEKS.
During the past TWO (2) WEEKS, how much (or how often) have you been bothered by the following problems?
None
Not at all
Slight
Rare, less than a day or two
Mild
Several Days
Moderate
More than half the days
Severe
Nearly every day
1. Little interest or pleasure in doing things?
4 Severe - Nearly every day
2. Feeling down, depressed, or hopeless?
4 Severe - Nearly every day
3. Feeling more irritated, grouchy, or more angry than usual?
4. Sleeping less than usual, but still have a lot of energy?
3 Moderate - More than half the days
5. Starting lots more projects than usual or doing more risky things than usual?
0 None - Not at all
6. Feeling nervous, anxious, frightened, worried, or on edge?
4 Severe - Nearly every day
7. Feeling panic or being frightened?
4 Severe - Nearly every day
8. Avoiding situations that make you anxious?
2 Mild - Several Days
9. Unexplained aches and pains (e.g., head, back, joints, abdomen, legs?)
2 Mild - Several Days
10. Feeling that your illnesses are not being taken seriously enough?
1 Slight - Rare
11. Thoughts of actually hurting yourself?
1 Slight - Rare
12. Hearing things other people couldn't hear, such as voices even when no one was around?
0 None - Not at all
13. Feeling that someone could hear your thoughts, or that you could hear what another person was thinking?
0 None - Not at all
14. Problems with sleep that affected your sleep quality overall?
2 Mild - Several Days
15. Problems with memory (e.g., learning new information) or with location (e.g., finding your way home?
1 Slight - Rare
16. Unpleasant thoughts, urges, or images that repeatedly enter your mind?
2 Mild - Several Days
17. Feeling driven to perform certain behaviors or mental acts over and over again?
0 None - Not at all
18. Feeling detached or distant from yourself, your body, your physical surroundings, or your memories?
0 None - Not at all
19. Not knowing who you really are or what you want out of life?
2 Mild - Several Days
20. Not feeling close to other people or enjoying your relationship with them?
3 Moderate - More than half the days
21. Drinking at least 4 drinks of any kind of alcohol in a single day?
0 None - Not at all
22. Smoking any cigarettes, a cigar, or pipe, or using snuff or chewing tobacco?
0 None - Not at all
23. Using any of the following medicines ON YOUR OWN, that is, without a doctor's prescription, in greater amounts or longer than prescribed [e.g., painkillers (like Vicodin), stimulants (like Ritalin or Adderall), sedatives or tranquilizers (like sleeping pills or Valium), or drugs like marijuana, cocaine or crack, club drugs (like ecstasy), hallucinogens (like LSD), heroin, inhalants or solvents (like glue), or methamphetamine (like speed)]?
0 None - Not at all
Current Status
Masters degrer
Are you currently attending school?
No
20 years
Medium
Medium
Have you ever been terminated from a job?
No
Are you currently receiving disability?
No
Are you an active member of the Armed Forces?
No
Have you ever served in the military?
No
Were you ever in combat?
No
Do you have an illness or injury related to your service
No
Family
Are you satisfied with your home and family life?
How socially active are you?
No
Rarely
Who do you most enjoy spending time with?
My children
How important is religion and/or spirituality in your life?
Very / Somewhat / Not at all
Somewhat
Are you physically active? Yes / Sometimes / No
Sometimes
Current satisfaction with lifestyle, hobbies, activities:
High / Medium / Low
Low
Please list your favorite activities, interests or hobbies:
Spending time with my children, attending sporting events, reading
Briefly describe how you spend a typical day:
Teaching, cooking, watching tv, sleeping
What do you like most about yourself?
I care about others
Please describe one of your favorite memories:
College and some family vacations
Current Relationships
My daughter
Are you currently in a committed romantic relationship?
Yes
If YES, with whom and for how long?
Married for 35 years
Quality of relationship: (Positive / Mixed / Negative)
Negative
Any current romantic relationship conflicts?
Yes
Are you concerned about any potential violence?
No
Any recent breakups?
No
If you have children, are there any current relationship difficulties?
Yes
If you are co-parenting with an ex-partner, any areas of concern or conflict?
No
Any relationship problems with other family members, (parents, siblings, etc.)?
Yes
Any conflict with others outside of family, (friends, coworkers, neighbors, etc.)?
No
To whom are you closest?
Physical, Home, Family, Relationships
Physical, Home, Family, Relationships
Mental Health Treatment History
Age at first mental health treatment:
22
Why did you seek/receive treatment?
Hard to remember, I think just transition to adulthood
Have you ever met with a therapist?
Yes
On and off over the past 40 years individually. Tried marriage counseling at least 4 times
If you would like me to consult with your previous therapist, please provide therapist information and sign your consent here:
January 26, 2026 at 4:05:12 PM
Beth Keen
Have you ever been hospitalized for a mental health condition?
No
If yes, please complete below:
Have you taken psychiatric medication in the past?
Yes
If yes, please complete below:
Effexor
Current
Any other psychiatric medication:
Providers
Primary Care Physician
Chelsea Hoshiwara
4806070060
11 2025
4806075809
Signature
Consent to contact Primary care Dr.
Yes
January 26, 2026 at 4:05:13 PM
Psychiatric Provider
Signature
Consent to contact psychiatric provider?
January 26, 2026 at 4:05:13 PM
Current Medications
Medication list attached separately?
Any concerns or troubling Side Effects with your medications?
No
If yes, please describe:
Psychiatric Medication
Medication
Dosage/Frequency
When prescribed
Side effects
Medical Medication
Medication
Dosage/Frequency
When prescribed
Side effects
Medical Status
How would you describe your overall health?
(Poor / Below average / Average / Above average / Excellent)
Average
Date of last complete physical exam:
Please list any significant findings:
Date of last dental exam:
07 2025
Please list any significant findings:
Has your life changed because of your health?
Are you currently undergoing medical treatment?
No
Yes
Current medical treatment
Diabetes
Please list any major illnesses, events or accidents from your medical history:
Diabetes
Do you use Medical Marijuana?
No
Do you regularly take pain medication?
No
Please indicate personal concerns with any of the following physical symptoms:
Arthritis, Diabetes
Skin Disorder
Other please specify):
Trauma History
Please indicate if you have ever experienced any of the following:
Other (please specify):
Verbal abuse
Help and support
Lasting emotional symptoms
Childhood History: Adverse Childhood Experience (ACE) Questionnaire
2
Did a parent or other adult in the household often…
Swear at you, insult you, put you down, or humiliate you? or
Act in a way that made you afraid that you might be physically hurt?
N
While you were growing up, during your first 18 years of life:
1
Did a parent or other adult in the household often…
Push, grab, slap, or throw something at you? or ever
Hit you so hard that you had marks or were injured?
N
Yes
No
3
Did an adult or person at least 5 years older than you ever…
Touch or fondle you or have you touch their body in a sexual way? or Try to or actually have oral, anal, or vaginal sex with you?
N
4
Did you often feel that…
No one in your family loved you or thought you were important or special? or
Your family didn’t look out for, feel close to, or support each other?
N
5
Did you often feel that…
You didn’t have enough to eat, had to wear dirty clothes, and had no one to protect you? or
Your parents were too drunk or high to take care of you or take you to the doctor if you needed it?
N
6
Were your parents ever separated or divorced?
N
7
Was your mother or stepmother:
Often pushed, grabbed, slapped, or had something thrown at her? or
Sometimes or often kicked, bitten, hit with a fist, or hit with something hard? or
Ever repeatedly hit over at least a few minutes or threatened with a gun or knife?
N
8
Did you live with anyone who was a problem drinker or alcoholic or who used street drugs?
N
9
Was a household member depressed or mentally ill or did a household member attempt suicide?
Y
10
Did a household member go to prison?
N
Mental Health History
Have you ever intentionally harmed yourself or seriously thought about doing so?
No
Have you suffered racial, sexual, or other forms of discrimination?
No
Do you have a history of alcohol or substance abuse?
No
Do you have a history of an eating disorder (restricting, binging, purging)?
No
Any history of gambling, shopping, sexual, or other behavioral addictions?
No
Do you have a history of unstable relationships?
Yes
Have you frequently changed jobs?
No
Have you ever had problems with your temper or violence?
Yes
Have you ever been convicted of a misdemeanor or felony?
No
Childhood and Family History
Illinois
Parents
Were you adopted?
No
Mother
Were there frequent family moves?
Parents:
(Married / Never married / Separated / Divorced)?
Married
Parental Relationship:
Positive, Close
Negative, Unstable
Infidelity, Abusive
Mother
New york
Did your mother work when you were a child?
Yes
Office work
Was you mother generally healthy while you were growing up?
Yes
Is your mother still living?
Yes
If deceased, please provide year of death:
If living, where does she currently live?
Scottsdale
Are you in communication with her?
Yes
Relationship with your mother growing up:
(Positive / Mixed / Negative / Abusive)
Positive
If separated or divorced, did mother remarry or have another partner?
If yes, describe your relationship with them growing up:
(Positive, Mixed / Negative / Abusive)
Father
Chicago
Did your father work when you were a child?
Yes
His occupation?
Management
Was you father generally healthy while you were growing up?
No
Is your father still living?
No
If living, where does he currently live?
If deceased, please provide year of death:
2019
Are you in communication with him?
Relationship with father growing up:
(Positive / Mixed / Negative / Abusive)
Mixed
If separated or divorced, did father remarry or have another partner?
If yes, describe your relationship with them growing up:
(Positive / Mixed / Negative / Abusive)
Siblings
Please indicate your birth order:
(Oldest / Youngest / Somewhere in the middle)
Somewhere in the Middle
How many siblings?
2
Siblings names and ages:
Michelle: 61
Marnie: 54
Are you in communication with some/all of them?
Yes
Do you have any family members living in the area?
Yes
Any problems with your delivery and birth?
Yes
Any developmental delays?
Yes
Childhood medical problems?
No
Any childhood hospitalizations or intense medical/dental procedures?
Yes
Did you have a favorite pet growing up?
No
What was your favorite thing to do as a child?
Baton twirl
During childhood, how did you cope with difficult situations?
Cried, hid
Indicate quality and experience of childhood home life (check all that apply):
Variable
Options
At what age did you leave home and why?
End of Childhood and Family History section
Education History
What type of student were you?
(Above average / Average / Below Average)
Who was most influential or helpful during your school years?
Mother, special education teacher
Average
Please indicate your school experience:
(Positive / Negative / Mixed)
Elementary School
Negative
Middle/High School
Negative
College
Positive
Year of high school graduation:
1983
Did you experience any of the following at school?
Learning Difficulties, Hurtful Teachers
Social difficulties
Relationship History
Age at first intimate relationship:
24
Any struggles with sexual orientation or sexual identity?
No
Are you currently in a long-term relationship?
Yes
If currently married, how old were you at the time of marriage?
26
How old was your spouse at the time of marriage?
27
Do you have children together?
Yes
If previously married, what age were you at the time of that marriage?
When did that marriage end?
Briefly describe why that marriage ended:
Did you have children together?
Family Mental Health
Anger Problems, Anxiety, Attentional Difficulties, Bipolar Disorder, Depression, Dementia, Health Problems
Learning Difficulties, Narcissistic Personality, Obsessive-Compulsive
Please indicate if any of the following mental health conditions are/were present or suspected in immediate or extended family:
Father, husband
Father, son
Husband
Father
Father, sisters, son, mothet
Father, aunt
Father, grandfathers, grandmother, mother
Father
Father
Father
Which family member(s) have negatively impacted you the most?
Husband, father
Please indicate how significantly you have been impacted:
(Not at all / somewhat / Quite a bit / Greatly)
Greatly
Strengths and Goals
What are your goals for treatment?
Learn how to reduce anxiety. Learn how to deal with my son and husband, learn how to feel joy
When did you last feel emotionally healthy?
Can’t remember
What are you wanting to change most about your life?
The constant emotional overload
How have you made it through difficult times before?
Yes
What do you consider your strengths?
Resilience
What experience have you enjoyed most over the past week?
Watching movies with my daughter
Please share a positive belief you have about yourself:
I’m a good person