Intake form

Help us serve you better

Name *

Email address *

What type of therapy are you interested in?

Please select at least one option.

Individual Therapy

Couples Therapy

Family Therapy

Group Therapy

Teletherapy

What is your primary reason for seeking therapy?

How did you hear about us?

What is your preferred method of communication?

Do you have any previous therapy experience?

What are your goals for therapy?

What days and times are you generally available for sessions?

Which service or services are you interested in?

Please select at least one option.

Individual therapy sessions

Couples therapy

Children and teens

Additional questions or comments

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