Intake form

Name *

Email address *

What is your preferred method of therapy?

Please select at least one option.

In-person

Virtual

What age group do you belong to?

What are your primary concerns?

Please select at least one option.

ADHD

Anxiety

Anger Management

Depression

Grief

LGBTQ+ Issues

Life Transitions

Men's Issues

Trauma/PTSD

Couples Therapy

Have you previously sought therapy?

If yes, what type of therapy did you receive?

What are your goals for therapy?

How did you hear about shane calhoun, Psy.D.?

Do you have any specific preferences for your therapist?

Additional questions or comments

Shane Calhoun, Psy.D.