New Client Forms | Creative Expressions Consulting, LLC
Please take 10-15 minutes to read through and fill out the following forms 24 hours prior to your first Art Therapy session with Lynn Cukaj.
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Client's Full Name *
Today's Date *
Parent/Guardian name if client is a minor
Home Address
Email Address *
Main Phone Number *
Can we leave a voicemail?
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Can we text you?
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How did you hear about Lynn Cukaj?
What are the current issues and concerns?
Medical information (diagnosis, allergies, medications, special needs/limitations, developmental level)
When did you first learn about diagnosis/condition/psychological concerns?
Family history & sibling information:
Psycho/social history:
Any previous treatment/therapy to address these concerns?
What are your short-term goals?
What are your long-term goals?
What are your/your child's strengths and interests?
Do you have art materials or creative preferences?
Additional information that would be helpful:
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