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ELEMENTAL Intake Screening 


    This screening form is appropriate for individuals age-16 and above. 
    Complete this screening only if you are actively seeking treatment support.
    Following submission of your screening, Michele will review it then connect with you to arrange 
    a consultation or intake.
    It is typical for this to take 2-3 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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