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Half-Light Counseling

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What’s bringing you to therapy right now?

Have you ever received mental health support before?

I am currently in therapy I have been in therapy in the past I have never been in therapy before

Are you currently or have you previously received any of the following care or supports?

(Select all that apply)

I am currently taking psychiatric medication I have taken psychiatric medication in the past I have been hospitalized for mental health reasons I have received intensive treatment (PHP/IOP/residential) None of these apply

A few important safety items to review (for appropriate care matching):

(These help ensure I can support you safely and appropriately.)

Currently experiencing thoughts of wanting to die or not be here Previously experienced thoughts of wanting to die or not be here Previous attempt of suicide in the past

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

Cameron Burke, LMHC

Massachusetts

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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.