Therapy Questionnaire
Fill out what you can openly, honestly and as fully as possible.  I use this information to make the most of our time together on the call to begin exploration. 

All information is completely confidential.
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Email *
What's your name? *
How old are you? *
Where do you live?
 *
What are you hoping to achieve out of therapy?
What challenge(s) would you like to explore?
What steps, if any, have you taken to overcome the challenges?
What would the perfect outcome look like for your situation?
Are you experiencing any of the following?  Tick all that apply
If you've selected any, can you expand on what you're experiencing?
Are you taking any medication or substances that impact your mental wellbeing?
Are there any habits you wish to change?  (To start, to stop, to do more of, to do less of)
How is your relationship with your immediate family?  What's important for me to know?
Have you worked with a psychiatrist, psychologist, psychotherapist or counsellor before? If yes, can you provide some information on what is important for me to know?  What did you find useful / not so useful?
What do you expect from me in my role as a therapist?
What can I expect from you as a client?
What should I know about how you think, operate, reach decisions and what motivates you?
Is there anything else you would like to share that I should know?
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