New Client Questionnaire
Welcome! The answers provided will help outline what you are needing from therapy and if Honesty Heals will be a good fit for you at this time. Once complete, please keep an eye out for confirmation of your free consultation appointment. Cheers to you for taking this first big step!
Full Name
*
First Name
Last Name
Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Where do you live? City, state?
*
Aspen only provides therapy services for Pennsylvania residents at this time
Are you ok with virtual therapy sessions?
*
Yes, let's continue!
No, this won't work for me.
How did you hear about Honesty Heals?
*
If someone referred you, give credit where it's due!
What brings you to therapy? What are you hoping to address? Please be as detailed as possible.
*
What are your goals for therapy? Please list at least three.
*
Is this your first time in therapy? If not, when was your last time? How was your experience?
*
What date and time work best for a complimentary 15-minute consultation?
*
New clients are required to attend weekly sessions for the first month in order to establish a rapport between therapist and client.
*
Yes, weekly is fine to start!
No, I cannot commit at this time.
Is there anything else important to know? Any questions you have?
Submit
Should be Empty: