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BENE THERAPY PLLC
INTAKE FORMS
After you have been connected to a Clinician from our Intake Team, please complete the Intake Form that applies to you below
ADULT INTAKE FORM
Please complete the Adult Intake Form if you are 18 years or older.
ADOLESCENT
INTAKE FORM
Please complete the Adolescent Intake Form if you are 13 - 17 years old. While you can legally complete on your own, it is recommended that you include your Parent/Guardian if they will be helping with payment and insurance.
YOUTH INTAKE FORM
Please complete the Youth Intake Form if your child is 5-12 years old. Parent/Guardian must complete form but is highly encouraged to include your child in the process.
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