Welcome.Please click on the link below to fill out the individual intake form. Individual Intake Forms Individual Intake Forms Name * First Name Last Name Date of Birth Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email * Emergency Contact * Name, Relationship, and Phone number Medications Individual Intake Questionnaire What can I help you accomplish? Have you sought therapy in the past? If so, anything negative or positive you experienced in that treatment? Have you ever had mental health emergencies in the past? Crisis 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? What time would be best in your schedule to meet for therapy? In session, would a more direct/challenging approach or collaborative/supportive approach, what is the best fit your style of communication? Is there anything else you would like me to know about you? Any other questions for me? Thank you!