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Client Intake Form

Please Complete This Form So We Know How To Best Support You

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Confidentiality is implied in submitting this form

Are you currently in therapy or working with another mental, emotional, or physical health professional?
What's your relationship staus?
Do you have children? (Check all that apply).
What support tools do you have at least some familiarity and experience with? (Check all that apply.)
What is your preferred time to do sessions?
Have you experienced any suicidal ideations / acts that have been not been addressed with a medical / psychiatric professional?
Are you currently taking any medication used for the support of emotional and/or mental health?

Thanks! Look For A Text and Email Shortly!

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