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  • Athens Parent Wellbeing Support Intake

    This form is for those who are becoming parents or who are parents/caregivers who would like to ask for support and get connected with our services. This includes professional therapy matching, therapy scholarships and/or peer support mentorship. This form will take approximately 15-20 minutes to complete. Please visit our website to learn more.

  • Disclaimer: At Athens Parent Wellbeing, we care about representing and addressing you correctly. Some of the questions in this form may feel more personal, but please know that both this form and our staff are HIPAA-compliant. HIPAA-compliant means your information is kept confidential and private. We encourage you to answer to the extent you feel comfortable. Your responses will help us connect you with the supports that best meet your needs.

  • Contact Information and Introduction

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  • Section 1 of 4: Family Dynamics and Support. This section will ask you questions about you, your family, and sources of support. 

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  • Section 2 of 4: Access to Therapy and Mental Health Experiences. This section will ask you questions about your experiences with therapy and accessing mental health care. 

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  • Section 3 of 4: Demographics. This section will ask you questions about you and your background.

    Disclaimer: We want you to know that your responses are confidential and will be kept private. We collect this information to align our services with your needs and to understand the community we serve as a whole. Please answer to the extent you feel comfortable to do so.
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  • Section 4 of 4: Reflection. This section will provide you with an opportunity to share personal reflections and let us know anything additional you'd like to share. 

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