Client Information
Email *
First Names
Last Name
Street Address #1
Street Address #2
City, State
Zip
Email Address 1
Email Address 2
Work Phone
Home Phone
A Very Brief History
Below you will find five questions I always ask every client in their first session. I am including them here so that you can answer in advance and save session time. 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: http://ow.ly/jm9K50ztxCg) *
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