Request appointment | Inner Balance Counseling

Inner Balance Counseling

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What is the reason for seeking care?

Anxiety Depression Grief Trauma Substance Abuse or Recovery Relationship Issues Stress LGBTQIA+ Issues Other

What kind of care is being sought?

Individual Counseling Couples Counseling

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Attempted suicide in the past None of these apply

Safety Agreement - Before you continue on to answer the questionnaire please carefully review the following statements. By checking below, you agree to the following: I am not currently in crisis or experiencing thoughts of self-harm or danger to myself. I feel safe and can wait to speak with client care about my needs.

If you cannot agree with the above statement and feel unsafe, please call 911 immediately or go to your nearest emergency room. Your safety is our priority.

Yes

I confirm that I am filling it out for myself and I am at least 18 years old.

Yes

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

Inner Balance Counseling

602.675.6185 |

Mesa

Main Location

Mesa, AZ 85206-3700

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.