Prescreening Form

Prescreening Form
Welcome to Thrive Behavioral Health

Please complete the information below. If you need help and additional information, please send an email to thrivecounselingjamaica@gmail.com or call (876) 833-5094.
Where did you hear about us?*

Google searchfamily or friendmedical doctornon-profit organizationother mental health professionalschoolOther
WHO IS COMPLETING THIS FORM?
Please state your full name:*

First NameLast Name
Are you completing the form for yourself or someone else?*

MyselfSomeone else
Please state your relationship to the client.*

SAFETY FIRST!
Is there any current threat of suicide or homicide?*

YesNo
Is there any current threat of intimate partner or domestic violence?*

YesNo
CONSENT FOR SAFETY

A consent for safety gives your word you will not harm yourself or anyone else and that you are not in immediate danger. If you are completing this form for someone else, please select the appropriate consent on their behalf.
Can you consent to safety at this time?*

Yes, I can consent to safety at this time.NO, I cannot consent to saftey at this time.

WHAT PROGRAM AND SERVICES ARE YOU INTERESTED IN?

AT THRIVE BEHAVIORAL HEALTH, WE OFFER INDIVIDUAL THERAPY, COUPLES AND RELATIONSHIP COUNSELING, PREMARITAL COUNSELING, GROUP THERAPY FOR TEENS AND ADULTS AND INDIVIDUAL COACHING.
Let's get you connected to the right service! Please select the services that you are interested in receiving. Select all that apply.*

Individual therapyCouples/relationship therapyFamily TherapyPremarital TherapyGroup Therapy (Adult)Group Therapy (teens)Coaching

TELL US ABOUT YOU/THE CLIENT!
Client's Information
CLIENT'S LEGAL NAME:*

First NameLast Name
CLIENT'S PREFERRED NAME:
CLIENT'S DATE OF BIRTH:*

MonthDayYear
Date
CLIENT'S SEX, GENDER, PRONOUNS
CLIENT PHONE NUMBER:*
Please enter a valid phone number.
WHATSAPP PHONE NUMBER (If different)
Please enter a valid phone number.
CLIENT EMAIL:*
example@example.com
Consent

Do you consent to Thrive contacting you on this number?This is a safe numberThrive Behavioral can leave a voicemail message.Thrive Behavioral can leave a whatsapp message or voicenote on this number.I agree to check the email provided above as communication is primarily through email.
Briefly tell us why you are seeking mental health services. Is there anything specific you want to focus on? *
LET'S TALK
Has anything significant happened recently to cause these feelings?*
How long have you been feeling this way?
Have you participated in mental health services before? If so, how long ago?
At some time, would you be interested in participating in a virtual support group? (Please indicate the specific group, if you are aware of one)

PAYMENT
Individuals: initial consultation sessions (first sessions) are $20,000 and last 90 minutes.

Individual follow-up sessions last 50 minutes and are $16,000.

Marriage/Couples/Relationship: initial consultation sessions are $24,000 and $20,000 per session thereafter.

Children: initial consultation sessions are $16,000 . Follow-up preteen and adolescent sessions (must be accompanied by parent) are $12000

I usually start working with clients on a weekly basis and then once there is some progress, we will move to biweekly.

Group therapy sessions range from $6000 to $8000 per session, with length varying by group.

Enrollment in a group program means that you are responsible for paying for the entire cost of the group. Payment plans can be made available.

All sessions are paid for in advance.

24 Hour notice is expected for all cancellations.
How long are you anticipating being in therapy?

I only need 1 sessionI would like to start with the recommended 4 to 6 sessions and then evaluateI am committed; however long it takesI am not sure I can afford therapy

You are almost done! On the next page, you will be able to submit your form. Depending on the options you chose, you will be redirected to the next step.

If your responses don't require follow up from a Thrive professional, you will be redirected to our scheduling page. Make sure to choose the service you selected in this pre-screen. Remember to complete all intake paperwork at least 24 hours prior to your first appointment or you may be asked to reschedule. Thank you!
I agree that I have completed this accurately to the best of my knowledge.

I agree
Should be Empty:

Welcome to Thrive Behavioral Health