New Client Intake Form

New Client Intake Form
General Information:
Name*

First NameLast Name
Date*

MonthDayYear
Date
Email*
example@example.com
How did you hear about my work?*
What is your primary reason or intention for working with me at this time?*
Do you have any current or past mental health diagnoses, or are you taking any medications related to mental health?*
Do you have a history of trauma that you feel would be important for me to be aware of?*
Is there anything else from your past or present that you feel would be helpful for me to know as we begin our work together?*
Should be Empty:

General Information: