How Are You Today?
Zones of Regulation Check In -  Welcome! Life happens and sometimes you may have some thoughts or feelings that you want to talk about. If you do, please fill out this form. I am the only person who will see your responses, so please answer honestly. Your answers will help me work with you to your concerns/needs are addressed and that you feel heard, safe and cared for. I look forward to talking with you. ~Ms. A., Mental Health Therapist
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Your Name
What time of the day is it?
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The Zones of Regulation
How are you feeling right now? Check the image above for a description.
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Why do you think you are feeling this way?
What would help you feel better?
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