Melinda Rockwood | SimplePractice

Melinda Rockwood Send Message

Your info

First name

Last name

Phone

Name you go by

Date of birth

Gender

State

Select the state you live in

Reason for care

What brings you to counseling at this time?

Welcome to Back to Basics Counseling. Taking the first step toward counseling isn't always easy, and we're honored you're here. The questions below will help us learn a little about your needs so we can provide the best possible care. This should only take a few minutes, and we'll personally review your information before reaching out. Please select all areas that you would like support with. This information simply helps us better understand your needs before we connect.

Anxiety & Excessive Worry Depression & Low Mood Stress & Feeling Overwhelmed Grief & Loss Life Transitions Self Esteem & Confidence Teen Challenges Family or Relationship Concerns Emotional Regulation Trauma or Difficult Past Experiences Women's Issues Faith & Spiritual Concerns Other

How would you prefer your first session?

In Person Virtual I'm not sure yet

Client Preferences

Is there anything that the practitioner needs to know?

For example: what you'd like to focus on, insurance or payment questions, etc.

Limited to 600 characters

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

By submitting this form, you agree to the processing of your sensitive personal information, which may include protected health information (PHI). This information may be viewed by team members in this practice. You also agree not to submit any payment information, including credit or debit card details, through this form.