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HEIMLER SCALE OF SOCIAL FUNCTIONING
The Heimler Scale of Social Functioning is an analysis tool which uses an interview process to
assess the life balance of a client. This form enables a user to self-administrate the interview
process. Analysis may be made by the use of the full program Rhsf.odb.
Preliminary Information
Name:
Date:
DOB:
Gender:
Marital Status:
Children:
Occupation:
Education:
Address:
Phone:
E-mail:
The following pages contain a series of forms which relate to different aspects of life. Please
answer each question with ‘Y’ or ‘N’ if your answer is clear, or ‘P’ if it sometimes applies and
sometimes does not.
You can pause, save and resume the process at any stage.
Vladimir
M
Marries