‘From Under the Rug’ Mental Health Therapy Intake Form
This form will ask you general questions and provide your therapist with a brief overview.
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First Name Last Name
Date of Birth
What is your preferred contact method? (Text is easiest and fastest way to communicate. E-mails will definitely come in the form of PayPal messages for invoicing, calendar invites for sessions, and notifications about changes with the practice.)
Emergency Contact Name
Emergency Contact’s Phone Number
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This form was created inside of FromUnderTheRug.