Therapeutic Intervention Assessment Form
Please complete this form to help us understand your fit, needs, and preferences for a therapeutic intervention. Your responses will guide us in tailoring the most suitable approach for you.
What is your primary goal for seeking therapeutic intervention?
*
How would you describe your current challenges or concerns?
*
Which style of intervention do you feel most comfortable with?
*
Structured and goal-oriented
Open and exploratory
A mix of both
Not sure
Please rate your comfort with the following intervention approaches:
*
Rows
Very Uncomfortable
Uncomfortable
Neutral
Comfortable
Very Comfortable
Talking therapies (e.g., CBT, counseling)
1
2
3
4
5
Creative/expressive therapies
6
7
8
9
10
Group-based interventions
11
12
13
14
15
Digital/online interventions
16
17
18
19
20
How ready do you feel to begin a therapeutic intervention?
*
Not ready
1
2
3
4
Very ready
5
1 is Not ready, 5 is Very ready
How would you rate your current support system?
*
1
2
3
4
5
Have you previously participated in any form of therapeutic intervention?
*
Yes
No
If yes, please briefly describe your previous experience.
What are your preferences regarding session format?
*
In-person
Online/virtual
Group sessions
Individual sessions
Other
What are your preferred days/times for sessions?
*
Submit Assessment
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