3) As your therapist, how can I best support you in achieving your goals? (Select All That Applies) *

I want to acquire healthier coping skills

I want to practice mindfulness and relaxation techniques

I want homework assignments to enhance my understanding of what we talk about

4) My approach to therapy is collaborative, which means we will work together as a partnership. However, your willingness to do the work outside of our sessions will determine what you get out of this process. With that said, how would you like to proceed? *

Yes. I'm ready to do the work, and I agree to actively participate in my treatment; in and out of session.

No. I don’t think this is a good fit for me, after all. I don't think I'd like to continue. Nevertheless, I would like to thank you for your time.

Client's Name *

First Name

Last Name

Today's Date *

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