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. Please note that we conduct therapy sessions in our office, with exceptions for telemedicine in cases of temporary illness. Please also note that David meets with couples, families, and men of any age, and boys if David has a therapeutic relationship with a family member. David does not meet one-on-one with women in the office.