Intake Form - Counseling (2026)
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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Email *
First & Last Name of person filling out this form today *
Today’s date *
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Type of Counseling Requested  *
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