Help me get to know you!

1. Contact information *This question is required.

First Name

Last Name

City

State

Zip

Age

Phone Number

Email address

2. What types of concerns would you like help with if we decide to work together? (Just a cliff notes version is fine here!) *This question is required.

3. What was it that drew you to contact me specifically? *This question is required.

4. Many of the folks who come to see me have been to other counselors before.If you've seen other counselors, what' have you found most and least helpful? *This question is required.

5. What's the best way to reach you: Phone call or email? Please let me know here if it's okay to send you a message on your phone and/or email. *This question is required.

6. What do you hope to gain from counseling? What will change for you if counseling works well? *This question is required.

7. I take video of our sessions using Zoom's encrypted, secure recording option. These are used only for further developing and refining my own skills and they're shown only in supervision. Taping helps me to review what helps you and lets me see moment by moment how to be most effective in helping you. Will you give me permission to tape our sessions? (We can always discuss this further in consultation -- if you answer yes now, it will authorize me to tape our consult so I can rewatch later and get a deeper sense of what's helpful for you right away.) *This question is required.

8. What's one thing you can do to improve something in your life or your mood (even just a little bit) between now and the time of our session? *This question is required.

9. "I understand that Michaela operates under Oregon's education exemption for counselors and Hence doesn’t look at concerns through a lens of disorders.If I'm seeking mental health diagnosis and treatment, I agree to find a different provider to help with that piece of the puzzle."

10. "I understand that you don't take insurance, and that's okay with me. I or someone who supports me can pay for my sessions."
*This question is required.

Yes
No, but please add me to your waiting list for reduced fee slots.

11. Would you like to be added to my newsletter list? I send out helpful resources and links to interesting videos and articles every now and again. *This question is required.

Yes
No thanks

Help me get to know you!

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