Mary Petersen, L.M.S.W., A.C.S.W., P.C. Search… Heal… Solve… Thrive…


Below are links to standard history questionnaires

You can download, print and fill out your history questionnaire prior to our first session. Please bring the completed form with you at intake. You may require the free Adobe Acrobat Reader for your platform in order to open, fill and print these documents.

Adult History (PDF)

Adult history should be filled out by you about yourself.

Student History (PDF)

Student history should be filled out by a minor (under age 18) about him/herself.

Parent History (PDF)

Parent history should be filled out by a parent/guardian about a minor client.

Private Consent (PDF)

Private Client Consent Form.