CLIENT INTAKE FORM
PERSONAL LIBRARIAN BIBLIOTHERAPY SERVICE
YOUR PRIVACY IS IMPORTANT
This form will help give your bibliotherapy facilitator an overview of what you hope to accomplish while using our Personal Librarian Service. Unless you give us permission, we will not share this information with any other party, except where required by law. This form, and the results of your sessions, will become part of your confidential client record.

If you have any questions, about the form or our organization, please contact our administrative support team at admin@wordshealinc.org or (630) 923-5417.

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