Adult Intake Form
The information you provide on this intake form is STRICTLY CONFIDENTIAL and will not be used to inform any criminal activity. It is important that you answer the questions below honestly in order that your therapist can tailor your care appropriately. We can assure you that your therapist will not judge you based on your responses, but will use them to understand your life, and provide you the highest level of care.
When completing each section, some elements may have a (?) which means you can expand the questions to gain additional information.