INTAKE FORM

Please provide the following information and answer the question below. Please note: information you provide here is protected as confidential information.

Please fill out this form and bring it to your first session.


Name of parent/guardian (if under 18 years):
Please note: Email correspondence is not considered to be a confidential medium of communication.


GENERAL HEALTH AND MENTAL HEALTH INFORMATION



FAMILY MENTAL HEALTH HISTORY

In the section below identify if there is a family history of any of the following. If yes, please indicate the family member's relationship to you in the space provided (father, grandmother, uncle, etc.




ADDITIONAL INFORMATION

Helpful Form

Get your paperwork filled out before you arrive.


Read More


Make an Appointment

Click here to schedule your appointment!


Read More