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Take all the time you need. There are no right or wrong answers — we just want to understand how to support you best. Everything you share is confidential.

Your feedback is anonymous if you prefer — the email at the end is optional.

For everyone's safety, please answer these brief questions within 24 hours of your appointment.

Telehealth lets your healthcare professional evaluate and advise you over a video call. It's a valuable tool, but it has limits: it doesn't replace a physical exam, and in some cases your professional may direct you to an in-person or emergency visit.

We use encrypted platforms to protect your information. Still, as with any technology, there is a minimal risk of technical failures or connection interruptions during the session.

What you share in session is confidential. There are limited legal exceptions: imminent risk to yourself or someone else, suspected abuse of a minor or vulnerable person, or a court order. Whenever possible, your therapist will discuss these with you before acting.

Therapy is a collaborative process. It can bring relief and clarity, and sometimes uncomfortable feelings along the way — that's a normal part of the work. You may ask about the approach or your progress at any time, and end the process whenever you decide.

Think about the last six months working with this person. Be specific: examples help far more than adjectives.

Date

Date of Nomination