Private Counseling for Addictive Behavior Change

Private Counseling for Addictive Behavior Change

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If you desire private counseling to learn to modify unwanted habits and manage your "addictive" behavior, please fill out the following confidential questionnaire.

I believe that it is completely unnecessary for you to label yourself as an "addict" or "alcoholic" in order to accomplish the changes that you desire! The below questions will help us save time. Filling this out will give me a sense of the behavioral challenges you wish to manage as I help you learn to accomplish—"better living through behavior change!"

Your contact info is Required so that I can respond to your call for help!
(Use an alias if you wish to hide your identity)

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  • All questions below are optional! Just provide as much information as you wish. You may leave any of the below questions blank. Remember, you may wish to reserve for later your most guarded secrets. You can assure your utmost confidentiality by saving some information for our personal-private counseling sessions!