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Confidential Client Intake Form (Loretta Carridan Luchau MA, LPCC, NCC, RMT)

Thank you for your answers--they will be held in strictest confidence.
Please allow 15-30 minutes to fill out the entire form (or we can fill it out together at your first appointment).  
1. Your contact info *This question is required.
3. Please read the required Counselor Disclosure Statement. *This question is required.Click here to view or download the Counselor Disclosure Statement in a new window.