Request appointment | Hope Counseling Center

What is the reason for seeking care?

Anxiety Attentional difficulties Behavioral issues Depression Grief Relationship issues Substance use Trauma Other

What mental health treatment has occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Attempted suicide in the past None of these apply

Developmental, Communication, and Support Information

These questions help us determine whether our outpatient counseling services are an appropriate fit, match you with a counselor, and identify helpful accommodations. Your answers do not automatically determine eligibility for services. Does any of the following apply to the person seeking care?

Autism spectrum disorder diagnosed by a healthcare professional Suspected or self-identified autism without a formal diagnosis Intellectual or developmental disability Another neurologic, genetic, or developmental condition that may affect counseling None of the above Not sure Prefer not to answer

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