Intensive Therapy Interest Survey
Please complete this survey to help us understand your interest and suitability for our intensive therapy programs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Have you previously participated in therapy or counseling?
*
Yes
No
What are your primary reasons or goals for seeking intensive therapy?
*
Which mental health concerns are you currently experiencing? (Select all that apply)
*
Anxiety
Depression
Trauma/PTSD
Relationship Issues
Stress/Burnout
Other
What types of therapy modalities are you interested in? (Select all that apply)
Individual Therapy
Group Therapy
Family Therapy
Cognitive Behavioral Therapy (CBT)
Other
What is your general availability for intensive therapy sessions?
*
Please Select
Weekdays (Daytime)
Weekdays (Evening)
Weekends
Flexible
Submit Survey
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