Intake Form

Share a few details before we meet. Submitting opens an email to me with your answers so nothing sensitive is stored on this site.

Your privacy

This website does not save, store or collect anything you type into this form.
When you press "Send to Marcy," your own email program opens with your answers filled in. Nothing is sent until you choose to send that email.
Your email goes directly to Marcy at mb.breathe@gmail.com and is kept confidential, in keeping with professional counseling ethics and applicable law.
Regular email is not fully secure. If you'd rather not share certain details by email, leave them out and we can discuss them in person or by phone at 717-712-2234.

Download the full intake form, fill it out, and bring it to your first session or email it to mb.breathe@gmail.com.