FormsIntake FormPlease Complete Prior to Our First SessionPlease enable JavaScript in your browser to complete this form.Name *FirstLastStreet Address *City, State, Zip Code *Phone Number *Email *Date of Birth *What brings you here? *Have you ever seen a counselor before? Was it helpful? Why or why not? *Overall, how would you describe your mood? *Do you take medications? If yes, what do you take and who is the prescribing doctor? *Any health/medical problems? *Hobbies/Interests: *Submit Outpatient Therapy AgreementPlease Download, Sign and Send Back to Us OUTPATIENT THERAPY AGREEMENT
