FEELINGS FORM

This form is designed exclusively for active and compliant Culmer Counseling clients to help you express your emotions as you feel them in the moment. By using this form, you acknowledge and agree that your email address, a timestamp, and your name will be automatically recorded when you respond and submit.

You have voluntarily accessed this link, and by proceeding, you agree that this tool is to be used solely for documenting your emotions in a non-emergency context.

Please remember:

• Review of this form will take place during your scheduled in-person or telehealth session. This form is a supplement to your therapy, not a replacement.

• This form does not replace your therapy appointment. It is a tool to help you track and communicate your feelings between sessions.

If you are experiencing a mental health emergency, please do not use this form. Instead, immediately:

• Click on the 988 Link Here or dial 988.

• If this is a medical emergency, please dial 911.