Legacy

Everyone leaves a legacy; what is yours?

The goal in gathering background information is to get an idea of what types of individuals will make up our Reading and Process group. The content in personal growth and change books has the chance of touching on personal issues, and I choose to air on the side of awareness to provide the best experience for you and all group members.  

The information your provide in here will be kept confidential.  It will be completely up to you to provide personal information inside of the group.  You are also welcome to speak directly with Dr. Sally H. Falwell if you have any questions about the questions, wish to provide additional information 

Name
Name
Date of Birth
Date of Birth
Primary Phone
Primary Phone
Have you ever seen a mental health professional (psychiatrist, psychologist, marriage and family therapist, social worker, counselor)?
Do you have a therapist you could work with if something came up in the group requiring individual attention?
If not, would you like referrals to therapists?
Please indicate if any of these are relevant to your background. As a reminder, your information is confidential and will not be shared with the group. These questions are asked to help provide an idea of the interests and variety that might be present in this Reading and Process group.

Thank you for providing this information!  

 

©2015 Sally H Falwell, PsyD, PC dba Legacy - Assessment, Counseling and Consulting

8117 Preston Road | Suite 682 | Dallas, TX | 75225 | 214 810 1718