Introductory Questionnaire

Introductory Questionnaire

The questionnaire is designed to build a foundation for therapy. By responding to these questions as thoroughly as you can you will be:

• Gather basic information about you more efficiently and effectively
• Helping me get to know you in a more focused way
• Providing a historical background for present concerns
• Directing attention to key areas
• Clarifying current concerns
• Preparing to develop a therapeutic plan

Your responses are strictly confidential, and protected by law to the extent of the law. No portion of this document will be released to others without your permission, except if required by law.

If you have any questions, please feel free to ask. Some questions may not pertain to you. If there is a question you do not wish to answer in writing, just let me know.

Please Choose One of the Options to Complete the Questionnaire

1. Print the questionnaire, fill in blue or black ink, and either return it to me via US mail or scan it as a pdf and return it via email.
2. Download the questionnaire, fill out the fields using a program like Adobe, Preview, or a similar application, and return it via email.