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ArtAwarett Client Intake
All information provided and content during sessions shall remain confidential unless permission is otherwise granted.
for more info contact us at ArtAwarett: +1868 328 6673 /
artawarett@gmail.com
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Email
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Your email
Name
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Your answer
Email
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Your answer
Preferred contact
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Your answer
Age
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Your answer
Profession
Your answer
Summarize briefly what issues you are needing help/ guidance with at the present.
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Your answer
Which symptoms/ problems are most concerning?
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Your answer
Current Stressors (Check all that apply)
Social
Health
Academic
Financial
Identity
Recent loss
Life transition
Coping Skills (check all that apply)
Affect skills
Access to social support
Exercise/ Movement
Monitoring/ Challenging negative thoughts
Journaling/ Writing
Creative outlet (state which)
Hobbies
Mindfulness/ Meditation
Faith/ Spiritual practice
Attention to self-care
Are you interested in any particular type of expressive arts (visual arts, writing, music, etc.)?
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Any relevant information/ history:
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