Pre-Interview Application • Encompass Mental Health

Below you'll find five questions that we ask you complete to apply at Encompass. Write as much as you feel is necessary. Please note, you cannot save this form and complete at a later time. We recommend reading the questions, answering them and then pasting in your answers when they are all complete. Thanks.

Name *

First

Last

Email *

Why did you become a therapist? *

How can Encompass help you grow as a therapist? *

What is the last really fun thing you did in your life, not at all related to being a therapist? *

You are working with a child from a separated family. After one of your sessions involving mom, dad and stepmom, the child's stepmom asks you privately to start seeing her daughter due to behavioral problems. How would you respond? *

How do you fit into the "Counseling for Real Life" mentality? *

Yes, I want to submit this form

By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.