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What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Nervous System & Emotional Regulation Other

What kind of care is being sought?

Psychotherapy Somatic Experiencing Lifespan Integration Other

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Attempted suicide in the past None of these apply

Are you currently experiencing suicidal thoughts or homicidal thoughts?

If experiencing suicidal thoughts, please call the National Suicide Prevention Line at 988 or 911 or go to your local emergency room.

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