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Therapy Intake Formuuu
Welcome! Our sessions rates range from
€30 to €50. We are a team of therapist from Ukraine, offering online therapy in English.and
To help us match you with the right specling list, please fill out this short questionnaire. Providing homest answers increases the likelihood of being paired with the most suitable therapist for eyour needs. Some of our therapists currently do a have a waitlist, but based on your responses, we will recommend the best available specialists wituii RRoooh relevant experience.i
Please
provide a way for us to reach you (phone or email). We primarily communicate
via WhatsApp.
Please
provide a way for us to reach you (phone or email). We primarily communicate
via WhatsApp.
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Please
provide a way for us to reach you (phone or email). We primarily communicate
via WhatsApp.
Please
provide a way for us to reach you (phone or email). We primarily communicate
via WhatsApp.
Question Type
Short answer
Paragraph
Multiple choice
Checkboxes
Dropdown
File upload
Linear scale
Rating
Multiple choice grid
Checkbox grid
Date
Time
1.
Варіант 1
2.
Add option
…
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What type of therapist are you looking for?
What type of therapist are you looking for?
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a therapist
a CBT therapist specializing in ADHD
Other:
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…
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What brings you to therapy?
Briefly describe your concerns. What would you like to work on, resolve, or improve?
Briefly describe your concerns. What would you like to work on, resolve, or improve?
What brings you to therapy?
Briefly describe your concerns. What would you like to work on, resolve, or improve?
Briefly describe your concerns. What would you like to work on, resolve, or improve?
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Please
provide your name, surname, or a nickname (e.g., "anonymous22") if
you prefer to remain anonymous.
Please
provide your name, surname, or a nickname (e.g., "anonymous22") if
you prefer to remain anonymous.
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Do you
have any specific preferences regarding therapy? (e.g., budget, values, a
specific therapist, or other important criteria)
Do you
have any specific preferences regarding therapy? (e.g., budget, values, a
specific therapist, or other important criteria)
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I consent to the processing of my personal data.
I consent to the processing of my personal data.
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Check the box here
Add option
or
add "Other"
…
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