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Reason for care

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1 Appointment info

2 Prescreener

Reason for care

3 Contact information

Which of the following best describe why you’re seeking therapy right now?

Please select all that apply to you.

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Life transitions Identity exploration Stress management Cultural or cultural identity concerns Neurodivergence (ADHD, Autism, etc.) Career or work-related concerns Other

What brings you to therapy at this time?

Please share a sentence or two about what you hope to work on. This helps me understand whether I’m the right therapist for your needs. No need for a full history here.

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

Not Another Therapist

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.