Client Information
Sign in to Google to save your progress. Learn more
Email *
First Names
Last Name
Street Address #1
Street Address #2
City, State
Email Address 1
Email Address 2
Work Phone
Home Phone
A Very Brief History
Below you will find five questions I ask every client at their first session. I'm including them here, so you can think about your answers. Please note that these answers come directly to me, and that answering here is completely optional.
Where were you born and raised?
If you have siblings, where do you fall in the birth order? What are the name and ages of your siblings?
What are a couple of adjectives you would use to describe your mom? Dad?
When did you meet your partner and what was the beginning of your relationship like? (Friends first? Slow attraction? Fast attraction? Etc.)
What brings you to therapy?
We have read and received the Orientation Sheet. (Click the following link to download the PDF: *
Clear form
Never submit passwords through Google Forms.
This form was created inside of WR Digital Marketing. Report Abuse