Client Intake Documents (Adult)

The pre-session survey is meant to be completed before each initial session. As with all client information, your responses will be kept strictly confidential. We will need some type of identifier to match your responses with your case that we have on file. This identifier could be the date and time of your initial session, or you could use the first three letters of your last name and first initial (include middle initial if your spouse has same first initial as you), or the last 6 digits of your phone number.

You are also free to complete this survey by hardcopy if you prefer. If you choose the hardcopy option instead, you can fax your completed survey to us at (833) 672-3280 (confidential fax) or bring it with you to your next session.

Please refer to the Privacy Policy for Tania M. Lewis Professional Services, PLLC. if you have any questions about privacy and your personal information.

This survey should take about 2-3 minutes to complete. Not every field has to be filled out, but you will need to finish what you intend to submit in one sitting as you cannot save a partially completed form and come back to it later to continue working on it. If you want to keep a copy for your own records, please print this page on your browser before you submit the survey.