Intake Form · Fu Qianshi

Fu Qianshi

New Client Intake Form · 新客户登记表

Before our first session, please take a few moments to complete this form. There are no right or wrong answers — this simply helps me understand where you are and how to be most present with you.

01 · Basic Information

First Name · 名

Last Name · 姓

Email · 邮箱

Phone · 电话 (optional)

Preferred Language · 偏好语言

English 中文 Both · 两者皆可

02 · About You

How did you hear about Fu Qianshi?

Have you engaged in philosophical counseling, therapy, or coaching before?

Yes No

What brings you here? (optional)

03 · What You're Looking For

Which service interests you?

Preferred session format

In person Online No preference

Anything else you'd like me to know before our first session? (optional)

04 · Agreement

I understand that philosophical counseling is not therapy, psychotherapy, or any form of licensed mental health service, and should not be used as a substitute for professional mental health care.

I have read and agree to the Client Service Agreement, including the cancellation policy, confidentiality terms, and limitation of liability.

Full Name as Signature · 签名

Date · 日期

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