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Daniel J. Fox, Ph.D
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Daniel J. Fox, Ph.D
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Applied Psychological Services, PLLC Psychotherapy Intake Form
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How did you learn about the psychotherapy services provided at this office:
REASON FOR SEEKING TREATMENT:
What has happened to cause you to seek help now?
What do you hope to be able to do or achieve as a result of treatment?
How do you handle stressors and/or cope with the problems you have described:
Reason for seeking treatment
Consultation only
Consultation and treatment
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