Vibrant Women Wellness Counseling, LCSW, PLLC
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Reason for care
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Appointment info
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Prescreener
Reason for care
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Contact information
What is the reason for seeking care?
Anxiety
Attentional difficulties
Behavioral issues
Depression
Grief
Relationship issues
Substance use
Trauma
Other
What mental health concerns or treatment have occurred in the past?
In therapy now
In therapy in the past
Taking psychiatric medication now
Taken psychiatric medication in the past
Hospitalized for mental health reasons now or recently
Hospitalized for mental health reasons in the past
Known neurologic or genetic disorder
Attempted suicide in the past
None of these apply
If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.
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