BirdWellness, PLLC | SimplePractice

Reason for care

What brings you to therapy right now? (Select all that apply)

This helps us better understand your needs and match you with the right clinician. You don’t need to have everything figured out.

Anxiety Depression or low mood Trauma or past experiences Relationship or family concerns Attention or focus difficulties Grief or loss Behavioral concerns Substance use concerns Something else / Not sure

Administrative

Referral source

Enter how you were referred to our services

Client Preferences

Preferred clinician

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If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

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.

Who would be receiving care?

Your info