Intake

Intake

*** Note: Please check your spam folder in your email for my reply. *** I'm glad you've taken this step to reach out. I'm currently accepting new clients for a limited number of time slots. If you'd like to work together, answering a few questions below helps me understand what you're looking for and whether we'll be a good fit. Once I've received the form, I will respond as soon as possible to let you know the next steps.
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Counselling setting preference:

In-PersonVirtual
Your scheduling availability: I see clients Monday, Weds, Thurs between 10am-6pm. Please be advised my practice is often busy, so it is easier for me to take on new clients with flexible/greater availability.

Flexible
Monday betweene.g. 11am-2pm and 3pm-5pm
Wednesday between
Thursday between Type a label
Tell me about what has you reaching out for counselling:
How many sessions would you like to attend?

Flexible6 or less6-12 sessionsLonger-term
I appreciate your patience until I'm able to reply, and look forward to connecting soon.

Warmly,

Sam
Should be Empty: