Name
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First Name
Last Name
Email
*
Phone
*
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What type of services are you looking for at this time?
Are you interested in telehealth or in-person services?
What, if anything, have you tried previous to therapy to feel better?
Have you ever participated in therapy before? If yes, how was your experience? What did you enjoy and what do you wish was different? If you haven't tried therapy before, what has held you back?
Please briefly share what issues are bringing you into therapy at this time:
What concerns do you have about therapy (if any)?
How severely are your current symptoms impacting your day-to-day life?
What questions do you have for me about myself or my practice? You may end up with more questions on our call. This question is just here to get you thinking about what you may want to ask me ahead of time. If you need an idea of a few example questions, below are a few that may help!
https://brittanymcgeehanphd.com/2020/12/14/cultivating-your-ideal-therapeutic-space/
How did you find my practice?
If other, please indicate below:
I reserve Tuesday 2-3 p.m. and Friday 2-3 p.m. for consultation calls. What is your preferred day and time to schedule within this time frame? * Please note that calls typically last 10-15 minutes and you will want to be in an environment that is quiet with good reception. Additionally, if this time block does not work for you, please share what times/days do work and we will find a mutual time that works for us.
Is there anything else you would like me to know before we jump on a call?
