Your Healing Journey Starts Here...
If you'd rather fill this out with someone over the phone, please call us at 313-288-2689!

These questions will help us to match you with a potential therapist who is a good fit.  Even if we don't have anyone who would be a good fit, we'll help you find someone who is.  

If you have any questions please feel free to contact us at info@establishingrecovery.com.

PLEASE DO NOT FILL OUT THIS FORM MULTIPLE TIMES.  IF YOU'VE ALREADY FILLED IT OUT AND NEED FURTHER ASSISTANCE, PLEASE EMAIL OR TEXT US.
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First Name *
Last Name *
Do you have any specific preferences for a therapist?
Do you want a specific counselor? If yes, then who?
Phone Number (will be used in client portal account) *
Email Address (will be used in client portal account) *
How do you prefer to be contacted by us? *
Required
What's going on with you that's causing you to seek counseling? *
How will you be paying for counseling? *
If you have insurance, what type of insurance plan do you have? *
Required
What is your availability for sessions? *
Required
Are you ok with online sessions? *
What are you looking for from your therapist? *
Required
How did you hear about us? *
Is there anything else you think we should know about?
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