Intake Form Please complete this form prior to your first schedule session Name(required) Email(required) What is your main reason for requesting services at this time? Please describe your current concerns – when did they start? how intense are they? how long do they generally last? what triggers them? Are you currently on any medications? Previous meds? Do you have any medical concerns? Do you currently use any recreational substances? If yes – what do you use and how frequently? What is your current job? What are your hobbies? How would you describe your support network? What are your current coping skills? Is there any additional information you want to share at this time? Submit Share this:TwitterFacebookLike this:Like Loading...
