• Welcome to Olson Family Counseling

    Thank you for reaching out. This form will take approximately 10-15 minutes to complete. Please answer all questions as honestly as possible so we can best match you with the right therapist. All information is kept strictly confidential and protected under HIPAA. If you are experiencing a mental health emergency, please call 911, call or text 988, or call Colorado Crisis Services at 1-844-493-8255. Do not use this form in an emergency.
  • Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is the client under 18 years of age?
  • Gender Identity*
  • Preferred Pronouns*
  • Race/Ethnicity
    • Parent/Legal Guardian Information – Clients Under 18 
    • Relationship to Client
    • Format: (000) 000-0000.
    • What is the current marital/legal status of the client's parents?
    • Contact Information 
    • Do you currently reside in the state of Colorado?*
    • Format: (000) 000-0000.
    • What type of therapy are you seeking?*
    • Are you interested in medication management services?
    • Insurance Provider*
    • Do you have reliable internet access for video sessions?*
    • How would you prefer to conduct your intake consultation?*
    • Do you have a specific therapist in mind?*
    • Which days are you generally available for sessions?*
    • What times of day work best for you?*
    • What type of therapy are you interested in? Select all that apply.
    • Have you been in therapy before?*
    • Are you currently seeing another therapist?*
    • How often are you currently using alcohol or substances?*
    • Have you experienced any thoughts of suicide?*
  • Should be Empty: