A View From Within Distance Counseling


CLIENT INFORMATION

Are you in treatment with a therapist now?



Are you happy with your current job?



Have you ever felt like harming yourself or someone else in the past?



Do you feel like hurting yourself or someone else NOW?



By checking the box below, you agree that you have answered this form honestly and that you are over 18 years of age.


A View From Within Distance Counseling

Kathleen Puckett LPC-MHSP, LADC, CSAT, DCC

1017 Hampshire Dr.

Maryville, Tennessee   37801

kathleen.puckettnoh8@hushmail.com

865-724-4923 (Confidential Phone)

865-982-3895 (Confidential Fax)