Check List

Read the statements and answer yes or no to all that apply. We will build you a printable checklist you can print out and bring to your healthcare provider. Please know we don't save your information.

see  hearing  feeling

I have seen, heard, or sensed things (e.g. people, animals, or objects) that others tell me are not actually there (hallucinations).

stealing  broken-heart

I have beliefs or fears that a loved one (perhaps a spouse, caregiver, or friend) is stealing from me or being unfaithful (delusions).


I sometimes feel out of touch with reality.


I have shared these experiences with my loved ones.


These experiences are having an impact on my family or caregiver.