Thrive Beyond Trauma Counseling — Pre-Screener
Confidential • Please complete all fields before your consultation

Pre-Screener

Thrive Beyond Trauma Counseling
37923 W. 12 Mile Rd., Suite C · Farmington Hills, MI 48331 · (248) 392-3733 · [email protected]
We are glad you are here. Taking this first step — reaching out — takes courage, and we want to meet you with care from the very beginning. This brief form helps us understand who you are and what you are looking for, so we can connect you with the right support. There are no wrong answers. Please take your time.
1About You
2Reason for Care
Check all that apply.
3Mental Health History
This section helps us understand your background so we can best support you. Please check anything that applies — this information is completely confidential.
4Scheduling & How You Found Us
Check all that apply.
5Billing & Payment
6Anything Else You’d Like Us to Know?
For medical emergencies, contact your healthcare provider or call 911.
For mental health crises, call or text 988.
By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.
Thrive Beyond Trauma Counseling · 37923 W. 12 Mile Rd., Suite C · Farmington Hills, MI 48331
(248) 392-3733 · Fax 657-439-3825 · [email protected] · www.thrivebeyondtraumacounseling.com