Take your time. Share what feels comfortable; there are no wrong answers. This helps your counselor understand how best to support you.
About you
What brings you in
How you've been feeling
Low mood Anxiety Sleep changes Low energy Difficulty focusing
Anything else you'd like to add:
Emergency contact
Confidentiality
I understand that what I share in counseling is confidential and will not be disclosed without my written consent, except where the law requires it — such as risk of harm to myself or others, or suspected abuse. I have had the opportunity to ask questions and I consent to begin counseling at Willow Path.
Client signature
Date
Willow Path Counseling · Everything you share here stays here.