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ELEMENTAL Intake Screening 


    This screening form is appropriate for individuals age-19 and above. 
    Only complete this screening if you are actively seeking treatment support.
    Following submission, Michele will review the form then connect you to arrange a consultation or intake.
    It is typical for this to take 3-5 days
    .  

    Please take your time and check only those items that apply to you.
    Please take your time and check only those items that apply to you.
    Please take your time and check only those items that apply to you.
    Please take your time and check only those items that apply to you.
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