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Katie Merricks Counseling, LLC
New Patient Waitlist
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Email
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Your email
Your name and phone number for contact:
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Your answer
Date of Completion:
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MM
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DD
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YYYY
Name and age of individual looking to participate in services:
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Self
Child
Other
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What services are you seeing to participate in?
Therapy Only
Psychological or Educational Testing Only
Gifted Evaluation
Applied Behavior Analysis (ABA)
Seeking Multiple Services
Other
I am seeking services due to the following concerns:
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Anxiety
Depression
OCD
ADHD
Autism (ASD)
Behavioral Difficulties
Learning Differences
Trichotillomania
Excoriation
Body Dysmorphic Disorder
Tics or Tourrettes Disorder
PTSD
Testing
Social Skills
Adjustment
Other
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Please share a little bit more about what you are seeking or experiencing above. If you are seeking evaluation services, please provide further information as well.
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