- Part One
(introduction) - Part Two
(Select Problems) - Part Three
(Any Medication?) - Part Four
(Subconscious Mind) - Part Five
(Contact Info)
Client Information (Confidential)
Before going ahead with Therapy over the internet or by telephone it is important that I have some information from you that will be relevant to your therapy. This form is designed to give me information that I can use to help you with your particular problems.
It is also designed to help you to begin thinking more indepth about your life and to view your life in a new way. Everything you write on this form is kept confidential and is transmitted over a secure server. Each question can be answered with as much or as little detail as you choose. All I ask is that you answer with the very first uncensored thought that springs to mind.
Clear my information and all forms and destroy this session.
