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Pre-Assessment Form

Our Pre-Assessment Form is the first step in providing you with the most appropriate care for your needs. Through this brief questionnaire, we gather essential information about your emotional state, reason for seeking help, and care preferences.

This information allows us to direct you to the most appropriate service, therapist, or program for you, ensuring a personalized and effective therapeutic experience from the start.

The process is completely confidential, secure, and designed to help you take your first step toward wellness with clarity and confidence.

Complete your pre-assessment form today and let us guide you towards the service that best suits you.

What type of consultation are you interested in?
How do you feel today?
Do you have a history of mental health conditions?
Forks
No
Have you experienced any changes in how you feel that have affected or are currently affecting your sex life?
Forks
No
Have you ever had suicidal thoughts?
Forks
No
Economically, do you feel protected against any event that may occur?
Forks
No
Are you or have you been a victim of any type of abuse or harassment?
Forks
No
Do you think your physical condition greatly influences how you feel?
Forks
No
Are you trying or have you tried to lose or gain weight, and no matter how hard you try, you just can't?
Forks
No
Have you recently suffered the loss of a loved one?
Forks
No
How did you hear about us?

I authorize Gautier & Associates LLC through Healthy Minds to contact me at the provided number via calls and text messages, including the use of automated dialing technology, for the purpose of providing me with information about their services.


-I understand that my consent is voluntary and is not a condition for accessing the services offered.

-I can opt out of receiving further communications at any time by submitting an opt-out request.

-My data will be treated with strict confidentiality, in accordance with the privacy policy of Healthy Minds.


Mobile information will not be shared with third parties or affiliates for marketing or promotional purposes. Sharing information with support service subcontractors, such as customer service, is permitted. All other use case categories exclude subscription data and text message sender consent; this information will not be shared with third parties.


I authorized Gautier & Associates LLC through Mentes Saludables to contact me at the number provided via calls and text messages, including the use of automated dialing technology, for the purpose of providing information about their services.


-I understand that my consent is voluntary and is not a condition for receiving services.

-I may opt out or further communications at any time by submitting an opt-out request.

-My information will be handled with strict confidentiality in accordance with Mentes Saludables privacy policy.



No mobile information will be shared with third parties/affiliates for marketing/promotional purposes. Information sharing to subcontractors in support services, such as customer service is permitted. All other use case categories exclude text messaging originator opt-in data and consent; This information will not be shared with any third parties.


Terms of Use

Privacy Policy

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