☐ I have completed my own intake form
☐ I used my own personal contact information
☐ I did not use another person’s email or contact information
☐ I can dedicate time for weekly sessions for approximately 4–8 weeks
☐ I can complete my appointment in a private setting
☐ The location is where no one can overhear the conversation
☐ I can speak freely
☐ I cannot be viewed by others
☐ I have completed the online ROI form if adults are involved in my care (parent, guardian, school staff, etc.)