CLIENT INTAKE FORM

Don't you hate it when you pay for an appointment with a therapist, only to find that when you get shown in, half your appointment is spent filling in a form and then the therapist sat there reading it? 

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Wouldn't you rather that time was spent actually treating you instead? Wouldn't that be fairer? 

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We think so too, so at State 11, we encourage you to fill in your medical history form before you come to see us, so that we can spend less time reading about you, and more time treating you. 

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It's just one of the ways we do things differently for you at State 11. 

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Simply fill in the form below and click submit!

Everything is stored securely on Google Forms, which is HIPPA and GDPR compliant.