GET CONNECTED WITH A THERAPIST Name * First Name Last Name Age * Phone * (###) ### #### Email What brings you to therapy? * Is there an immediate medical or psychological crisis? * YES NO Legally, we need to ask if you are currently a danger to yourself or others * YES NO Are you currently involved in the court system or a DCFS Case? * YES NO How did you hear about us? What else would you like us to know to help you find the best therapeutic fit? Thank you, we will reach out to you within 24 hours.
