Client Intake Form

Personal Information

Intake Questions

If you are experiencing suicidal thoughts or feel unsafe, please note that we are not a crisis service. Call 911 or 988 (Suicide & Crisis Lifeline) immediately for urgent support. You may also call our office for additional referrals or visit our resources page here: https://www.findyourbalancecenter.com/resources

If you’re experiencing suicidal thoughts sometimes, we encourage you to schedule a consultation call with our team so we can better understand your needs and discuss appropriate next steps. Please call us at 818-927-0478 to book your consultation.

If you are experiencing suicidal thoughts or feel unsafe, please note that we are not a crisis service. Call 911 or 988 (Suicide & Crisis Lifeline) immediately for urgent support. You may also call our office for additional referrals or visit our resources page here: https://www.findyourbalancecenter.com/resources

If you are experiencing suicidal thoughts or feel unsafe, please note that we are not a crisis service. Call 911 or 988 (Suicide & Crisis Lifeline) immediately for urgent support. You may also call our office for additional referrals or visit our resources page here: https://www.findyourbalancecenter.com/resources

If you are experiencing hallucinations, delusions, or feel unable to stay grounded in reality, we are not able to provide emergency care—please contact 911 or go to the nearest emergency room. You may also call our office for additional referrals or visit our resources page here: https://www.findyourbalancecenter.com/resources

If you are using insurance and are also seeing another mental health provider, please note that insurance typically does not allow coverage for overlapping services. We will need to review this before moving forward.

If you are seeking court-mandated therapy, we’ll need a copy of the court order or referral to ensure we meet the court’s requirements.

Thank you for letting us know. We currently offer services through telehealth only, which requires access to a private space. If your situation changes or you’d like to learn more, we’re happy to help.

After the intake session, your clinician will provide a professional recommendation regarding session frequency (e.g., weekly or biweekly) based on clinical assessment and treatment needs. While you have the right to decline this recommendation, choosing a frequency different from what is recommended may be considered against clinical advice and could impact treatment progress and outcomes.

Insurance Information

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Disclaimer: Find Your Balance, Center for Growth & Change is NOT a crisis hotline. This intake questionnaire helps us understand your needs and determine whether our services—particularly telehealth—are an appropriate fit.

Please note that we are NOT a crisis service. If you are in immediate danger or need urgent support, call 911 or 988 (Suicide & Crisis Lifeline).