Astute Counseling & Wellness — Pre-Match Questionnaire

Help our intake team understand your needs before matching you with a therapist.

Please correct the errors described below.
Use a number where our intake team can reach you.
Optional — share your pronouns if you would like.
Astute provides adult therapy services.
Briefly describe the concerns or goals that would help us match you with an appropriate therapist.
Share history relevant to therapist matching. Enter None or Not applicable if there is no relevant history.
List diagnoses given by a professional that are relevant to your care. Enter None if you have not received a diagnosis. A diagnosis is not required to request therapy.
List relevant current medications, or enter None. Do not include prescription or account numbers.
Describe relevant recent treatment, or enter None.
Enter your occupation or Not applicable.
Describe your communication style or enter No preference.
Include morning, daytime, and evening availability, along with any scheduling limits.
Enter a therapist name, No preference, or Help me choose. Availability may vary.
Enter your preference or No preference, and whether you are open to other available clinicians.
How did you hear about Astute? Enter Not sure if you do not know. Avoid entering someone else’s private health information.
Enter your gender identity, or Prefer not to say.
Enter the identities you would like us to consider for matching, or Prefer not to say.

Your information will be encrypted.

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