Intake Forms

For new clients, please fill out the following intake forms:

  • Center for Healing Assessment
  • Informed Consent 
  • Social History 

If you are beginning couple's therapy, please fill out the DAS-1 along with the previously mentioned forms.  These will give us a picture of where you are and help us develop a collaborative treatment plan.  

 

For men struggling with pornography

Click on the link below to fill out a 10-minute assessment that will help you see the extent of the problem.  You will then receive a score ranging on a continuum from 1-7 along with practical tips for moving forward.  You may enter your therapist's email address at the end of the assessment to have it sent to him/her.  This assessment was developed by Dr. Kevin Skinner.  http://www.assessingpornaddiction.com/