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Online Intake Form

Barrington H. Brennen, MA, NCP, BCCP

Marriage and Family Counseling Services

Nassau, The Bahamas

1-242-327-1980  *   barringtonbrennen@gmail.com

 

All the information given below is held in strict confidence. 

Only Barrington Brennen, will receive the information.

* Required fields

Marriage & Counseling Service Intake

Who Are You? *

You full name.   

Where do you live? *

P.O. Box, Town, Country  

Your telephone(s) *
Your email address *
 

Reasons for requesting therapy *

Marriage problems
Individual problems
Depression
Anger problems
Anxiety
Stress
Alcohol
Drugs
Gambling
Sexual Abuse
Intimate Partner Abuse
Incest
Rape
Poor Communication
Other
What is your gender? * Male
Female
You can write here any information about why you need therapy *
Are you requesting eTherapy? I am not living in your town but I really need your help. Therefore doing therapy via Skype will be helpful.
I can travel to your town for the first session or more, but might need to have eTherapy some of the time.
Attach a Clear Photo of Yourself *

 

After clicking "Send" watch your email. 

Within 24 hours you will receive a response to make

arrangements for you first session.

 

 

 
Guidelines For Sharing the Information On This Site
Permission is granted to print these pages and to make the necessary copies for your  personal use, friends,  seminar, or meeting handout.  You must not sell for personal gain, only to cover the cost to make copies if necessary.    Written permission (email) is needed to publish or reprint articles and materials in any other form. Or you call at 242-327 1980.  Copyright 1999 Sounds of Encouragement. All rights reserved.   Articles written by Barrington H. Brennen, Counseling Psychologist, Marriage & Family Therapist.  P.O. Box CB-13019,  Nassau, The Bahamas.     question@soencouragement.org