Let's Unwind with the Evans
Individual Counseling Services
Preliminary Information
Name
First Name
Last Name
Partner's Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Individual Counseling Questions
What motivated you to seek individual counseling at this time?
Can you describe any current challenges or concerns you're facing?
How would you describe your current support system (family, friends, community)?
Please Select
I have close family members I can rely on
I have supportive friends
I have a partner or spouse who is emotionally supportive
I have professional support (e.g. therapist, coach, mentor)
I'm part of a supportive community or group (e.g. church, social, recovery)
I have some support, but it feels limited
I feel mostly alone or unsupported
I'm not sure how to describe my support system
Have you ever participated in counseling or therapy before?
Yes
No
What are your main goals or hopes for counseling?
Improve emotional well-being
Manage stress or anxiety
Enhance relationships or communication
Work through past trauma or grief
Navigate life transitions or decisions
Improve work-life balance
Is there anything you feel is important for your counselor to know about your background or identity?
How often would you like to attend counseling?
Weekly (one day)
Twice a week
1 x month
2 x month
Submit
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