Intake form

Help us serve you better

Name *

Email address *

What type of counseling services are you interested in?

Please select at least one option.

One-on-one counseling

Group sessions

Marriage counseling

Family counseling

How did you hear about us?

What is your preferred method of communication?

What is your age range?

Do you have any specific goals for your counseling sessions?

Are you currently in therapy or have you been in the past?

Do you have any previous experience with counseling services?

What challenges or issues would you like to address in counseling?

Additional questions or comments

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Feli-Fortunate Counseling Services