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Consultation Information Form
The following questions are designed for me to understand your needs and ways I can assist you in this therapeutic process. Please fill out all questions accurately.  
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Client Name: *
Todays Date *
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What made you decide to seek support at this time? *
What feels most difficult or distressing in your life right now? *
How are these challenges affecting your school/work, relationships, or home life? *
How have you been coping with challenges so far? *
What are you hoping to get out of this consultation or support? *
On a scale from 1 to 5 (With 1 being lowest, 5 being highest) how important is it for you to work on these concerns? *
On a scale from 1 to 5 (With 1 being lowest, 5 being highest) how ready are you to start therapy and commit to the process? *
How did you hear about Mind Resolutions Clinical Services, LLC? *
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