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Healing starts hereāare you ready to take the first step?
What type of therapy are you looking for? *
Select one...
Individual (For myself)
Couples (For Myself and My Partner)
Teen (For My Child)
Do you consider yourself to be religious? *
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Yes
No
Have you ever been in therapy before? *
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Yes
No
What are your expectations from your therapist? A therapist who... *
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Listen
Explores my past
Teaches me new skills
Guides me to set goals
Assigns me home work
I don't know
Are you currently experiencing symptoms of depression, anxiety, trauma, or any other mental health issues? *
Select one...
Yes
No
What specific challenges or issues are you currently facing that you would like to address in therapy? *
How long have you been experiencing these issues? *
Are there specific triggers or events that have escalated your current issues? *
How would you describe your current emotional state on a daily basis? *
Are there any underlying physical health issues or medication that might be affecting your mental health? *
What days and times are most convenient for you to attend sessions? *
How do you currently cope with stress or difficult emotions? *
On a scale of 1-10, how motivated are you to work through your issues in therapy? *
What is the name of your health insurance? *
First Name *
Last Name *
Mobile Phone Number *
Email *
Require *
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