Intake Form
For each person attending therapy: Please enter your responses as completely as possible; it will help us in our work together. Answered questions have no limit to their length. Please note that you do not need to answer most of the questions on the form — answering them here will save us time in session, so we can address the issues you came for, instead of answering these questions during our time together. Still, if you would prefer not to answer any question that is not required, simply leave it blank. A printable version of this form can be found here. State of Wisconsin Statutes protect the confidentiality of clients who share information with a marriage and family therapist, with notable exceptions, including disclosures of child abuse or neglect and imminent danger to yourself or others.