Getting started

New client questionnaire

This brief questionnaire can help you think through what you are looking for before requesting a consultation.

Your privacy matters.

This questionnaire is not submitted or stored through this website. You may complete it for your own reference and bring your responses to a consultation. Please do not email private medical or trauma details.

About youPreferred namePronouns, if you would like to shareBest phone numberEmail addressPreferred way to be contacted

What are you looking for?Type of supportWhat would you most like support with?What would you hope to feel or do differently through therapy?Have you worked with a therapist before?

Preferences and availabilitySession preferenceDays and general times that work bestPayment preferenceHow did you hear about Angelique?

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To print or save, use your browser’s Share or Print option after completing the questionnaire. Your entries remain only on this page and are not sent to Angelique.