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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? *
Select one...
Yes
No
Have your teen ever been in therapy before? *
Select one...
Yes
No
What are your expectations from your therapist? A therapist who... *
Select one...
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 concerns or issues are you observing in your teen's behavior or emotions that prompted you to seek therapy? *
How long have these issues been present, and have there been any recent changes or escalations? *
Are there specific triggers or events that have escalated your current issues? *
How would you describe your teen's 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 your teen's currently cope with stress or difficult emotions? *
On a scale of 1-10, how motivated are your teen to work through your issues in therapy? *
What is the name of your health insurance? *
(Parent) First Name *
(Parent) Last Name *
(Child) Full Name *
(Parent) Mobile Phone Number *
(Parent) Email *
Require *
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