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Confidential client intake

Mental Health Intake

Thank you for taking this step. This form helps your clinician understand you before your first session. It takes about 20–30 minutes, moves one step at a time, and lets you go back to review your answers before you submit. Share only what feels comfortable — you can always discuss anything in session.

Need help right now?

This form is not monitored in real time and is not an emergency service. If you are in danger or thinking about harming yourself, call or text 988 (Suicide & Crisis Lifeline), call 911, or go to the nearest emergency room.

Your privacy

Your responses are submitted securely and reviewed only by authorized clinical staff involved in your care. Consents, policies and releases are completed separately in your client portal.

Page 1 out of 10
Date of Birth
Month
Day
Year
Preferred Contact Method
Email
Phone Call
Text Message
OK to Leave Voicemail?
Yes
No
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