Therapists, Counseling, Counselors, Louisville, Kentucky, Marriage Therapy, couples

Developing Authentic Happiness Intake Form for Intro Class

Instructions
Please fill out the form below, and click the SUBMIT button at the bottom of the screen to send us your request.

Your Name:	*
Phone Number:	*
E-mail Address:	*
Has anyone in your biological family ever been diagnosed with Clinical Depression, or do you suspect that someone may have been depressed and not diagnosed?
Are you aware of harboring resentment and unforgiveness toward anyone from your past?
NOTE: It is impossible to proceed in a healthy way if you are currently out of control with an addiction to drugs or alcohol. If this applies to you, a class such as this will not help you at this time. I would strongly recommend that you call your local Alcoholics Anonymous or Narcotics Anonymous phone number. The number for AA is 502- 582-1849 in Louisville, Kentucky. Are you in need of therapy for addictions and would you like a call back from Anne Milligan? Call 502-423-0220.
I understand that the contents of this form will be transmitted confidentially and will be kept confidential.*

(Fields marked with * are required)