Please take some time to reflect and answer the questions. This will allow the therapist more insight on what your needs are, the nature, severity, and impact of your difficulties, to assess any functional impairment, and your stressors, along with your strengths and resources.
By filling out Intake questions ahead of time, this will allow the therapist more face-to-face time with you at your first visit to help build your treatment plan with you and begin your journey to emotional wellness.
There are 23 questions which should take you about 10-15 minutes to complete. You will need internet access to complete or you can ask for a printed copy to be emailed to you if you prefer!
Consent to release to/from Alliance for Healing client information or verbal communication
Having a big sale, on-site celebrity, or other event? Be sure to announce it so everybody knows and gets excited about it.
Parent/Guardian to fill out for child ages 4-10
Client ages 11-17 to fill out
Parent/Guardian to fill out for adolescent ages 11-17
Parent/Guardian to fill out for child ages 4-10 when requested as a follow-up
Client ages 11-17 to fill out when requested as a follow-up
Parent/Guardian to fill out for child ages 11-17 when requested as a follow-up