Counseling Forms

These forms take most clients about 20 to 30 minutes to read and fill out, so it is recommended that you complete them prior to your visit.

 

If you are seeking individual counseling, please print and complete:

  • Adult History Questionnaire (see below)

 If you are seeking counseling for your teen, please print and complete:

  • Teen History Questionnaire (see below)

If you are seeking counseling for your child, please print and complete:

  • Child History Questionnaire (see below)

I am happy to answer any questions you have about any of these forms. Please e-mail or call with any questions or concerns. We will discuss these forms during your first session. If you do not have access to a printer or do not complete them prior to your visit, please let me know and I will have the forms available before your appointment. I  just ask that you come about 30 minutes early to allow yourself adequate time to complete them.

Thank you and we look forward to meeting you at your first visit!

 

Child History Questionnaire
Fill out the Child History Questionnaire before the first session.
Child History Questionnaire.pdf
Adobe Acrobat document [568.1 KB]
Teen History Questionnaire
Fill out the teen history questionnaire before the first session.
Teen History Questionnaire.pdf
Adobe Acrobat document [438.2 KB]
Adult History Questionnaire
Document for adult, individual clients to fill out before first session.
Adult History Questionnaire.pdf
Adobe Acrobat document [427.1 KB]

Contact Us Today!

Authenticity Counseling
6409 Odana Rd.
Madison, WI 53719


Phone: 608-628-7147

E-mail: tricia@authenticitycounseling.com

 

Schedule an appointment

 

 

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