Online Client Intake Form

Thank you for completing this. It helps me to better assist you during therapy. The information you provide here is protected as confidential information.

Please note: this form may take a while to complete.

If you are unable to finish it in one session, you'll have the option to save and complete later. This option will send you a custom link via email. Please double check your email to ensure it is correct. While this option is available, we recommend completing the form in one session to avoid potentially losing your entries.

When you are done, click the SAVE button.  Be sure to review the page after submission for any messages.  If it was successful, you will see a thank you notice.  Otherwise, there are errors on the form that need to be fixed before resbmitting the form.