Pre-Counseling Questionnaire

Please complete this form prior to starting services. For the multiple-choice questions, please select the option that describes your experience of yourself within the last few weeks.

Name

First Name

Last Name

Date of Birth

YYYY

How did you find out about YWCA Greater Austin counseling services?

1. I am able to manage my emotions.

2. I am able to make positive life choices

3. I am able to follow-through with goals I set for myself.

4. I know how to seek help when I need.

5. I am able to make and sustain significant relationships.

6. I know how to keep myself safe.

7. I trust my ability to meet my basic needs (housing, school, etc.).

8. I'm able to communicate my feelings and needs effectively.

9. I have an adequate social support system.

Once you have completed the Pre-Counseling Questionnaire, please complete the Working Agreement.

Working Agreement

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