Request appointment | Wildwood Wellness

Request an appointment

What made you decide it was time to seek therapy?

Was there a specific event, or situation, that motivated you to reach out?

Limited to 600 characters

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

What are the primary challenges in the relationship currently?

Ex: Same fight, different topic; difficulty connecting to one another; dissatisfaction with sex life, etc.

Limited to 600 characters

Are there any safety issues or ongoing affairs in the relationship currently?

Answers will remain confidential and therapist will follow up individually for more information if needed

Limited to 600 characters

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.