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Peace Joy Love | Safe & Secure Online Counseling

Precounseling Questionnaire

** ALL question must be answered in order for the form to submit successfully **

1. Your Name
2. Your e-mail address
3. What is the main problem, as you see it?
4. What have you done about it?
5. How can I help? What are your goals/expectations in our time together?
6. As you see yourself, what kind of person are you? Describe yourself....age/sex/location/culture/etc...
7. Is there any other information you'd like to share?