"Change Happens Because Of A Caring and Listening Ear"

Please describe in detail the incident that has led you to seek anger management:

When did the anger episode occur?

Where did the anger episode occur?

With whom?

What happened?

What actions did you demonstrate during the angry episode? Physical Verbal Threats/Property destruction Other: Explain:

Explain how did you feel physically while you were angry? Tense/Rush/ Strong

How did the angry episode end?

Were there any use of alcohol and/or drugs by anyone involved? Yes or No. If yes, who

Was this incident typical? Yes or No.

Duration: When you become angry, how long to you remain angry?

Intensity: On a scale of 1 to 10, with one representing no anger and 10 representing explosive anger rate the intensity of your anger during the angry episode.,

Frequency: How often have you had trouble with your anger:

This time only
This month only
Last six months
Since childhood
As an adolescent
Only as an adult

ANGER/AGGRESSION

Anger/aggression gets worse when drinking alcohol or beer or drugs
I only get in trouble with my anger/aggression while drinking alcohol or beer or drugs.
I’m less angry/aggressive when I drink alcohol or beer or use drugs.
Others tell me there is a connection but I have trouble believing it.
There seems to be no connections at all.

Is there any family history of bad temper, assaults, homicides or suicides? If so who

In general, what did you learn about anger from your family?

User Agreement

You agree to the following rules of the anger managment program:

1. If you miss 3 anger management session/classes/hours you will be discharged from the anger managment program.

2. If you are 15 minutes late you can be not allowed.

3. If you are late on a consistent basis you can be charged a late fee of $10.

4. You have do what your court order says to do. If your court order says complete classes/sessions and you want to complete all or some of your classes/sessions in our 1-Day Intensive Program which is 6 or 8 hours, you will still have to pay the regular fee of each class/session as if you were coming to the weekly classes.

5. The anger managment classes/sessions are on Tuesdays (5 pm - 6 pm), Fridays (6 pm-7 pm and Saturdays (9 am - 10 am); and the 1-Day Intensive Anger Managment Class are on Saturdays at 3 pm.

Today's Date