Basic Information Sheet Please briefly answer the following questions: Please enable JavaScript in your browser to complete this form.Name *FirstLastPhone Number *Email *1. What is the main problem, as you see it? What brings you here for counseling?2. What have you done about it?3. In what way(s) have you contributed to the problem? *4. What can we do? What are your expectations in coming here? *5. As you see yourself, what kind of person are you? Describe yourself. *6. What, if anything, do you fear? *Submit
