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The Arizona Therapist LLC

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Reason for care

Select date & time

1 Appointment info

2 Prescreener

Reason for care

3 Contact information

What is the reason for seeking care?

Anxiety Depression Grief Relationship Issues Trauma Other Self-Esteem Codependency Attachment Issues Boundaries

What mental health concerns or treatment have occurred in the past?

In therapy now In therapy in the past Taking psychiatric medication now Taken psychiatric medication in the past Hospitalized for mental health reasons now or recently Hospitalized for mental health reasons in the past Known neurologic or genetic disorder Attempted suicide in the past None of these apply

Are you currently or have you in the past experienced thoughts or plans of harming yourself or anyone else (Suicidal Ideation, Homicidal Ideation, and/or Self-Harm)?

Yes No

If you answered "yes" to the previous question, please describe when the thoughts and/or plans last occurred.

Limited to 600 characters

If you or others are in immediate danger or experiencing a medical emergency, call 911 immediately.

The Arizona Therapist LLC – Brittany Mullins, LPC

602.883.2779

Scottsdale, AZ

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You have the right to receive a Good Faith Estimate of what your services may cost.

Main Location

7464 East Tierra Buena Lane Suite 204
Scottsdale, AZ 85260-1643

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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.