Your Individual Therapy Intake Form
The information you enter will be encrypted automatically as you complete the form, before being sent out to the server. The information will then be added to your file by our admission department so your therapist can have access to it at the start of your session.
Please complete and submit this form without closing your browser, refreshing the page, or leaving it idle for too long, as any entered information may be lost, requiring you to start over!
Warmly,
The Blake Psychology Team