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  • HOME
  • COUPLES
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  • OTHER
    SPECIALTIES
    • Family Therapy
    • Individual Therapy
    • Premarital Therapy
    • Infidelity Therapy
    • Therapist Support
  • ABOUT
    • About CCCF
    • About Jonathan
    • About Courtney
    • About Kate
    • About Alice
    • About EFT
    • FAQ’s
  • BLOG
  • LOCATIONS
    • South Denver
    • Westminster
    • Fort Collins
    • Telehealth
  • CONTACT
Intake Form – IndividualJonathan Zalesne2021-04-09T07:22:52+00:00

Individual Intake Form

  • Individual Intake Form

  • What would you like me to call you in therapy? For example, if your first name is Jonathan but you would prefer to be called Jon, type Jon here. If you just want me to use your first name, retype your first name here.
  • If you have no cell phone, enter the best phone number to reach you.
  • For example: Male, Female, Trans-man, Trans-woman, etc...

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1502 S. College Ave Fort Collins, CO 80524
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