Question 1 of 12
What led you to seek help today?
Question 3 of 12
What type of counseling are you looking for?
Question 4 of 12
What is your gender?
Question 5 of 12
What is your orientation?
Question 6 of 12
Do you consider yourself to be religious or spiritual?
Question 7 of 12
Have you ever been in counseling or therapy before?
Question 8 of 12
How would you rate your current physical health?
Question 9 of 12
Are you taking any medication for your mental health?
Question 10 of 12
Are you currently taking any other medications or supplements?
Question 11 of 12
Is there any other information you would like to provide?
Question 2 of 12
Are you currently having any thoughts of suicide or hurting yourself?
Question 12 of 12
Would you prefer to have a telephone or video consultation?