Which therapist would you prefer to meet with?
Type "Susan Griffith" or "Richard Cooper" or "either".
At which office would you prefer to meet?
Type Durham (Durham/Chapel Hill office) OR Graham (Alamance County/Graham office)?
When are you able to come to our office for therapy visits (days with time ranges?)
What is the most perfect time of day (for instance, 4:30 pm, 12 noon, etc.) for you to start your sessions with us? Is that for all days, or just one day?
Type your full name
Type your date of birth
Type your email address.
Type your phone number.
Do you receive texts there? (Type Yes or No)
Take out your medical insurance card. Fill in the information required:
Type the name of your insurance company.
Type your insurance number.
Type the name that your insurance company uses for you.
Type the address that your insurance company uses for you.
Type your date of birth.
What goals do you have for your work with us?
What would you like to ask us?
How do you want your visits with us to be different from any prior counseling?
Share any family (or other) names, ages, and descriptions that you wish to share.
Give us family, social, work or educational information you care to share.
Tell us about current and past health concerns.
What else do you want to tell us now? (About anything)
Your responses are sent to our private and secure email account at state-of-the-art secure Swiss email service ProtonMail.
