Q. What type of therapy are you looking for?**
Q. What is your gender identity?**
Q. How old are you?**
Q. How do you identity?*
Q. What is your relationship status?*
Q. Do you consider yourself to be religious?*
Q. Which religion do you identify with? (Optional)
Q. Do you consider yourself to be spiritual?*
Q. Have you ever been in therapy before?*
Q. What led you to consider therapy today?*
Q. What are your expectations from your therapist? A Counsellor who...*
Q. Are you currently experiencing anxiety, panic attacks or have any phobias?*
Q. Are you currently taking any medication?*
Q. Are you currently experiencing any chronic pain?*
Q. How would you rate your current financial status?*
Q. Which of the following resources would be useful for you?*
Q. How do you prefer to communicate with your Counsellor?*
Q. Are there any specific preferences for your Counsellor?*
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Q. Please mark all that apply*
Q. I prefer a Counsellor with experience in... *
Q. Are there any additional areas you are interested in? We may not be able to honor all the preferences, but we will do our best!*
Q. What brings you here?*
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