INTAKE FORM

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1. What are the areas you would like us to focus on during our sessions? What problems to resolve? What goals to achieve?

2. What are the 3 most important changes you would like to make in your life? What prevents you from making these changes?

3. How will you know you have made these changes?

4. What have you done so far to solve the problem, to reach the goal? What worked and what didn’t?

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