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Consultation Questions
Please complete and submit your responses prior to our consultation meeting. These questions helps us make the most of our time together.
* Indica que la pregunta es obligatoria
Name, pronouns
*
Tu respuesta
Tell me about your most pressing issue.
*
Tu respuesta
How ready are you to engage in counseling?
*
Not at all, want to learn more
1
2
3
4
5
Let's schedule an intake appointment; I've done my research and I'm ready
Tell me more about the number you chose.
Tu respuesta
How did you find me?
*
Referred by a person**
Google Ad
Google Search
Directory (Psychology Today, Career Counseling Connection)
Otro:
Obligatorio
**If you are comfortable, please share who sent you my way.
Tu respuesta
I understand that Amanda: (check both boxes to acknowledge your understanding)
*
does NOT accept insurance and does not provide superbills for out-of-network benefits
charges $225 per 50 minute session
Obligatorio
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