St. John's Cathedral Counselling Service DBT Skills Group Online Intake Form
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Full Name
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Contact Phone Number
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Age
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Gender
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Marital Status
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Nationality/Ethnicity
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Primary Language
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Occupation
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Have you experienced psychiatric/mental health issues?
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Are you currently in therapy/counselling?
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Do you have any thoughts of hurting yourself or others?
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Are you currently involved in any legal proceedings?
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Top three (3) concerns:
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Additional information
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A copy of your responses will be emailed to the address you provided.
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