Intake Form 

Below is an online intake form. To provide some level of security over your personal information it will only be linked to your initials and your intake appointment time. You will be asked to fill out hard copies with identifying information at your intake session as well as sign a printout of your answers. This form is only for clients who already have an intake appointment scheduled. Please, have this form filled out and submitted a full 48hrs before your scheduled intake session unless otherwise discussed with me. If you feel uncomfortable submitting online, just let me know and I'll send you a PDF version to print/fill out and bring to session or have a hard copy waiting for you at your appointment. I recommend that you arrive at least 15-20 minutes early if you plan to fill out these forms in office. 

Take a deep breath, there are a lot of questions. Know that these are to help me get a better understanding of your needs as we start treatment. I'm so glad that you're taking this step to take good care of yourself and look forward to seeing how I can help! 

Thank you for filling out these forms! Please, make sure that you have completed all four of the questionnaires: Identity, General Health, Relationships & Sexual Health, and Mental Health. Below are forms for your reference. Please, review them as you will be asked to acknowledge that you received and accept them when you arrive at session.