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1 on 1 Sessions

Thank you for your interest in working with me. Please complete the form below to help me understand your needs and determine how I can best support you. Your responses are confidential.

Birthday
Day
Month
Year
Preferred Contact Method:
Are you currently under the care of a physician, psychiatrist, or other mental health professional?
Yes
No
Are you currently taking any medications related to mental health
Yes
No
Preferred session format:
Online
In Person
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By submitting this form, you acknowledge that this is an initial intake form and does not establish a therapist-client relationship until agreed upon. You also confirm that the information provided is accurate to the best of your knowledge.


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