Intake Questionnaire

The MCPST Intake Questionnaire asks for information about you, the issues that bring you into the clinic and your treatment goals so that we can best provide services for you.

You can download a printable copy of our MCPST Intake Questionnaire.

Please visit our MCPST Forms page for information about how to use this form if you are a new client.

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Midwest Center for Psychotherapy & Sex Therapy · 6300 University Avenue, Suite 125 · Middleton, WI 53562 · (P) 608-237-8000 · (F) 608-237-8005