• Please provide the following information. All information provided is private and will be protected by confidentiality and Health Information Protection Act (HIPA).
  • If you are a couple seeking couples counseling, please fill these forms out separately
  • Do not fill the forms out together because I want you to be open and honest without fear of your partner/s seeing the information.
  • Please fill out before your first session
  • You can print and fill the forms out by hand and turn them in during your first session. Client Intake Form
  • Do your best as you can to answer each question, if any question makes you feel uncomfortable please skip the question.