New Client Intake


CLIENT CONTACT

IMPORTANT NOTE ABOUT SERVICES:

Porchlight Counseling offers 20 free sessions to students who have survived sexual assault while enrolled at a college or university. If you are seeking counseling for sexual assault that occurred while you were underage, or after you graduated, you will not be eligible for the Porchlight Counseling program. If you are not eligible, please contact porchlight@clsw.org for referral information.

CLIENT SUMMARY

(Please describe the situation you are seeking counseling services for and write down personal goals that you hope to achieve through counseling.)

  • CLIENT INFORMATION

    • Be as specific as possible. Include times that you are available.Example: 8am – 10am instead of writing morning.

    HISTORY

    • PLEASE LIST THE REASON FOR HOSPITALIZATION AND THE DURATION

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