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CSM Counseling

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1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What are your (your child's) primary reasons for seeking counseling?

What areas of your (or your child's) life feel the most challenging?

Thoughts (difficulty maintaining balanced or helpful thoughts about yourself, others, or the world) Emotions (difficulty managing feelings like fear, sadness, panic, or anger) Social (difficulty engaging with others or feeling disconnected from your community) Interpersonal (difficulty developing, improving, or maintaining healthy and supportive relationships) Life Activities (difficulty managing daily work, home, or school responsibilities) Self-Care & Compassion (difficulty balancing your own needs, wants, and desires with the needs of others) Physical (challenges with appetite, sleep, or physical health that impact your mood) Adjustments/Life Transitions (significant life changes that are difficult to navigate) Difficult Past Experiences (past events or memories that are still heavily affecting your current life) Other Stressful Events (any other experiences or stressors you would like to address)

Engagement with mental health care

Check all that apply.

In counseling/therapy now with a licensed professional In counseling/therapy in the past with a licensed professional Taking psychiatric medication now, managed by my prescribing provider Taken psychiatric medication in the past Hospitalized for mental health care now or recently Hospitalized for mental health care in the past None of these apply

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

CSM Counseling

713.828.7742

Stafford

Main Location

Stafford, TX 77477-2635

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.