Intake for free therapy
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Email *
First and last name ( what you go by)
Have you had therapy before?
If yes, what was you experience like?
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What type of therapy?
Who is your support system?
How do you cope with stress
Current problems
What goals do you hope to accomplish as a result of our working together?
What is your education history?
Current Employment
How do you describe yourself? 5 adjectives
Which topics interest you?
Best time of day for booking sessions
Clear selection
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