Questionnaire All information you provide is 100% confidential. Name* First Last Email Phone*1. What are you currently struggling with?2. What outcomes are you hoping for? Do you have any specific therapeutic goals?3. Is there a specific type of therapist / therapeutic style you prefer?4. Do you have any concerns about therapy? If you've ever tried therapy or counseling before, how/why did it end? What do you not want to happen in a therapy session?5. Obstacles - what might get in the way of meeting your goals? What might prevent therapy from being a worthwhile or helpful experience for you?6. How soon do you need to have an appointment set up?7. Any special requests (for example, location, cost, insurance, treatment modality)?CAPTCHA2 + 3 =*
