New Client Intake Form

If you are new, please fill out the New Client Intake Form before our first session. This form can also be filled out during the first session.

To receive access to the New Client Intake PDF Form, please complete the Step 1 form below. After you download the New Client Intake PDF Form by saving it to your computer or device, fill it out, then save it and return to this page. After completing and saving the New Client Intake PDF Form, upload it using the Step 2 form below.

Step 1: Download New Client Intake Form

Step 2: Upload New Client Intake Form

Name(Required)

First Last

Phone(Required)

Email(Required)

Emergency Contact(Required)

Enter the name and contact information for your emergency contact

First Last

Emergency Contact Phone(Required)

Emergency Contact Email(Required)

PDF intake form

Upload your completed and saved PDF intake form

Accepted file types: pdf, Max. file size: 16 MB.

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