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Your Free Telephone Consultation

Please complete the Confidential Survey below. This will be forwarded directly to Scott Sulak. After reading it, he will call you to set up a free telephone consultation. Having this information will allow your conversation to be more specifically directed to the nature of your needs. You may mutually decide to set an appointment for a session at his Kirkland, Washington office.

OR

If you prefer to speak directly to Scott before sending any information, call 425-822-8095. Leave a detailed message stating your name, daytime and evening telephone numbers and the nature of your call. He will call you back for a Free Telephone Consultation. During that call you may decide to set an appointment for a session. He will be able to set that appointment with you.

Confidential Client Survey

 Name: Home Phone:
 Address:
 City: Age:     Sex:
 Email:
 Appointment Time Desired:
      Mornings:     AM to AM
      Afternoons: PM to PM
      Evenings:     PM to PM
 Best Method to contact you to confirm an appointment:
     
     
     

  Here is a list of life-area and common dificulties which often lead people to seek professional assistance. Please check those you feel may also apply to you. You may add any items we missed.

Alcohol / Drug Usage
Low Energy Levels
Obsessive / Compulsive
Headaches
Communication
Depression
Unrestful Sleep
Eating / Weight Control
Workaholic
Everyday Fears


Guilt Feelings
Insomnia
Lying / Cheating
Money Worries
Shameful Feelings
Phobias
Chronic Pain
Relationships
Relaxation
Panic / Anxiety Attacks


Self-Motivation
Lack of Sex Drive
Shyness
Stress / Tension
Unpleasant Dreams
Self Esteem
Work Problems
Incest or Sexual Abuse
Heart Problems
TMJ / Teeth Grinding



Briefly describe why you are seeking counseling: