Professional Guidance Intake Form

Who do you live with?

Loved Ones Acquaintances Alone My guilty conscience Ghosts of my ancestors

Tell us about your eating lifestyle

keto all raw meat Vegan None

How intense is your emotional distress?

Rock Indie Country

How did you find us?

friend/acquaintance business card by accident family member

When did the problems start?

everpresent on an appropriate timescale soon

ok but on the down low what’s your legal status?

alive organ donor citizen on a visa civilian employee

Tell us how religion has permeated your existence.

pray in near death situations regularly say “oh my god” raised catholic agnostic crucifix over every doorway i have vandalized a gideons bible in the hotel nightstand

Hey girl, what was your highest level of education?

school of life school of hard knocks school of rock

How about that employment status?

woefully unemployed Joyfully unemployed woefully employed

Be honest, do you lie?

Honest and true blue Never to you Only for personal gain Maliciously and frequently

Are you currently taking any medication? You can tell us.

Yes, prescribed Yes, Street No

You got