Intake Form

For each person attending therapy: Please enter your responses as completely as possible; it will help us in our work together. Answers have no limit to their length. You do not need to answer most of the questions on this form — answering them here saves us time in session, so we can address the issues you came for. State of Wisconsin Statutes protect the confidentiality of clients who share information with a marriage and family therapist, with notable exceptions, including disclosures of child abuse or neglect and imminent danger to yourself or others. We conduct therapy sessions in our office, with exceptions for telemedicine in cases of temporary illness.

Meshel meets with any adult clients, couples, and minors if Meshel has a therapeutic relationship with a family member.

David meets with couples, families, and men of any age, and boys if David has a therapeutic relationship with a family member; as a matter of policy, David does not meet one-on-one with women in the office.