Client Intake Form
Thank you for choosing Therapy! Below are some questions that will help me to understand your current difficulties and your expectations from therapy. This will help me to plan ahead and use your scheduled time efficiently.
Email *
Name
Age
Address
Email ID
Occupation
What are your Pronouns?
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Have you attended therapy sessions before?
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How was your previous therapy experience? What worked and what did not work for you?
Your answer
What are you currently struggling with? How long has this been happening?
Your answer
Did you have recent life changing event? ( Death in the family, divorce, financial difficulties, health issues etc.) Please mention what they were if the answer is Yes.
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