Welcome.Please click on the button below to fill out the family intake form. Family Intake Form New Form Name * First Name Last Name Email * Birthdate Phone (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Family Intake Questionnaire What can I help you and your family accomplish? Have you (or your family members) sought therapy in the past? If so, anything negative or positive you experienced in that treatment? Have you (or your family members) ever had mental health emergencies in the past? Crises such as: panic attacks, debilitating depression, suicidal feelings and/or attempts, any hospitalizations for mental health? If so, how long ago and what was the treatment for it? Do conflicts ever escalate beyond anything verbal? What time would be best in your schedule to meet for therapy? In session, would a more direct/challenging approach or collaborative/supportive approach be beneficial; what is the best fit for your style of communication? Is there anything else you would like me to know about you? Any other questions for me? Thank you!