My practice is full at this time. To be added to a wait list, please fill out the contact form.
Intake for Therapy | Section #1
The following items constitute some preliminary information that will assist me in understanding you and your needs. Please send your responses by e-mail to me at firstname.lastname@example.org Take as much space as you need; don’t restrict yourself to the space available on this sheet. If you prefer not to respond to any of the items, leave them out. If applicable, we can explore those items at a later date.
All personal information is confidential and is treated appropriately.
Intake for Therapy | Section #2
We following questions will allow me to get to know you better as we begin our work together.