Office Survey

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OFFICE SURVEY

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* Indicates required field

Initials *

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Last

1. As vaccines are more widely available, what type of therapy sessions are you interested in? *

I'm ready to do IN PERSON sessions at the office I'm NOT ready, ONLINE ONLY I'm interested in a HYBRID of in person and online sessions I'm not sure yet It depends I'm from outside the Twin Cities, I'll continue to be ONLINE ONLY

Explain more about your choice on question #1: (Please provide as much information as possible) *

2. If you would like to do IN PERSON sessions, would you be willing to wear a face mask during your therapy session *

Yes No Unsure

3. Would you prefer a plexiglass barrier instead of face masks? *

Yes No Unsure

Explain more about your choice on question #2 and #3: (Please provide as much information as possible) *

What other comments/concerns do you have about in person/online sessions & safety in the office: *

Submit

**Please note that email is not a secure and confidential form of communication. Please do not include private/confidential information.

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Brave Choices, Inc. is a Twin Cities counseling practice located on Očhéthi Šakówiŋ and Wahpekute land at
1575 7th St. W. Ste. 104, Saint Paul, MN 55102, 612.889.7517

This practice believes that BLACK LIVES MATTER.
We are inclusive and all are welcome.

Heather Holt, MSW, LICSW offers mental health counseling for individuals and families at this location.
St. Paul, MN skyline painting print was produced by Katie Swanson. Used with permission. Image is copyrighted.

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