Private preparation
Initial Information Form
Complete only what feels useful. This form does not ask for your name, is not submitted, and is not stored by this website.
Your privacy: Your answers remain temporarily in this browser. Free-text answers can still contain identifying information, so avoid names, addresses, birth dates, employer names, or other details you do not want shown in a saved copy. Print, save as PDF, or screenshot the form and bring it to your appointment.
What brings you to counseling?
Optional. A few sentences are enough.
Areas where I would like support
Previous mental-health experience
Optional diagnoses or past concerns I would like my counselor to know about
General background
Support system
Medication or health information
Optional. You are not required to list medications or medical information here. Share only what you feel comfortable bringing to your counselor’s attention.