Begin Healing Today! Name * First Name Last Name Phone * (###) ### #### Email * Session Type * Individual Therapy Couples Therapy Clarifying Question 1. What the Presenting Problem(s) Current Level of Stress/Distress due to Issue? (Scale 1-5 low to high) 1 2 3 4 5 Would you be open to working with one of our in-office colleagues if they are available sooner? Yes No Thank you for taking the time to complete this form. Your responses will greatly assist us in tailoring our approach to meet your unique needs. We will be in touch soon to discuss the next steps of a consultation or begin session. If you have any immediate questions or concerns, please feel free to reach out via call/text to 720-257-9263 Schedule your Initial Session to Get the Support that you Need.john@known.care(720) 257-9263
