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Intake Form
Welcome! I’m looking forward to talking with you. I’ll try to make this process as simple as possible!
1) You’ve already “booked” a session on davidroper.net.
2) Now, complete this online Intake Form.
3) Last, watch the “Welcome” video on the Video Library (DavidRoper.net/VideoLibrary)
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* Indicates required question
Email
*
Your email
Type of Counseling Requested
*
Individual Counseling for an Adult
Individual Counseling for a Teenager
Marriage/Couples Counseling
Family Counseling
Pre-Marriage Counseling
Required
Today’s date
*
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/
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Name of person filling out this form today
*
Your answer
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