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 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.
