Help us match you to the right therapist

It's important to have a therapist who you can establish a personal connection with. The following questions are designed to match you to a licensed therapist based on your therapy needs and personal preferences.

Which state are you in ? *

Date of birth *

What is your gender identity? *

Gender plays an important role in shaping personal identity and experiences. This information will help your therapist create a more personalized approach.

Would you like to be matched with a therapist who specializes in LGBTQ+ issues? *

What is your relationship status? *

Which religion do you identify with? *

Would you like to be matched with a therapist who provides Christian-based therapy? *

What led you to consider therapy today? *

This is a preliminary question to understand what you are going through, you will have more opportunities to explain or elaborate on your feelings and challenges later on.

Are you currently experiencing overwhelming sadness, grief, or depression? *

Over the past 2 weeks, how often have you been bothered by any of the following problems:

Trouble falling asleep, staying asleep, or sleeping too much. *

Over the past 2 weeks, how often have you been bothered by any of the following problems:

Trouble concentrating on things, such as reading the newspaper or watching television. *

Over the past 2 weeks, how often have you been bothered by any of the following problems:

Thoughts that you would be better off dead or of hurting yourself in some way. *

Are you currently experiencing anxiety, panic attacks or have any phobias? *

In the last month, Have you experienced strong negative thoughts or feelings (such as guilt, shame, fear, or anger) related to a past event/experience?

*

Do you try to avoid thinking about a past event or avoid people, places, or situations that remind you of it?

*

Have you felt constantly on guard, jumpy, or easily startled?

*

I prefer a therapist with experience in....

*

Additional focus areas i prefer ...

*

What brings you here?

*

Answering this question will help your therapist know where to begin ....

First Name

*

Last Name

*

Email Address

*

Phone Number

*

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.

Yes, I want to submit this form & agree to the terms of use. *

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