Intake Questionnaire for the Online Support Program

1. Eligibility Screener

Thank you for your interest in our Therapy Bytes program.

Please note:

1) This program is designed for people experiencing mild to moderate levels of psychological distress. If your results indicate you fall outside of the mild-moderate range you will need to be in active treatment with a mental health clinician in order to access the program.

2) If you are an existing 12 Points Psychology client, by completing this questionnaire you are giving 12 Points Psychology permission to share your results with your treating clinician.