Facebook
Twitter
Instagram
About
About
Step
1
of
10
10%
Name
First
Last
Email
Phone
What brings you to counseling at this time?
Is there something specific, such as a particular event?
What are your symptoms (sad, anxiety, poor sleep, changes in appetite, etc.)?
How long have you been experiencing these symptoms?
When did your symptoms worsen?
In what ways have your symptoms impacted work, relationships, and caring for yourself?
Who are the people in your life that will support your transformation journey?
Are you looking for weekly or every other week appointments?
What is your availability (days, evenings, weekends)?
What do you hope will be better for you after counseling?
