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Mandatory

Important Questions We Must Ask

Once the form is completed and submitted, you will be contacted within the next 24 business hours for a short courtesy call (10 minutes or less) for consultation purposes. Please, fill in the data with the same reservation information: Your name and surname, email and contact number.

IMPORTANT: Once the form is sent, the site will be redirected to the appointment reservation request. Keep in mind that sending this form is mandatory and an essential condition for the approval of the appointment.

In case of doubts, you can consult the frequently asked questions or contact us:

FAQ
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    Have you ever had thoughts of killing yourself?

    YESNO

    Have you ever planned on killing yourself?

    YESNO

    Have you ever attempted to kill yourself?

    YESNO

    How long ago you have been experiencing thoughts or have you attempted to kill or harm yourself?

    Has anyone in your family or close to you died by suicide?

    YESNO

    Have you ever felt you wanted to seriously harm or kill someone else?

    YESNO

    Do you have weapons in your home or access to weapons?

    YESNO

    Is there any history or presence of abuse or violence?

    YESNO

    Are you currently using any illegal drugs or prescription medications in a way other than was prescribed, or is the reason you are seeking therapy services substance related?

    Have you ever witnessed or experienced a trauma? Do you have recurring nightmares, flashbacks, or do you avoid anything that is uncomfortable or painful?

    Do you have currently legal issues or is the reason you are seeking therapy related to a court order?



    Once the form is completed and submitted, you will be contacted within the next 24 business hours for a short courtesy call (10 minutes or less) for consultation purposes.

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