All Good Things Psychological Services Professional Corporation

All Good Things Psychological Services Professional Corporation Send Message

Who would be receiving care?

My partner and me

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Reason for care

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Immigration issues Family Conflict Political Climate concerns other

What are your goals for therapy?

If therapy were to be ideal, at the end of treatment, how would your life be different?

I would be able to manage my emotions I would understand why I feel the way I feel I would have a better relationship with my loved ones I would be able to ask for help when I need it without feeling shame I would be able to use healthier coping strategies than before I would learn to love myself more

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past Current or past thoughts of death or wanting to die current substance use none of these apply

Administrative

Referral source

Enter how you were referred to our services

Driver's license upload

Do not upload sensitive financial information such as credit card information.

Client Preferences

Preferred appointment times

Morning (9am-11am) Afternoon (1pm-4pm) Evening (5pm-7pm; only on Tuesdays)

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.