Request appointment | Janessa Nikols, LCPC

Janessa Nikols, LCPC

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Reason for care

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1 Appointment info

2 Prescreener

Reason for care

3 Contact information

In your own words, what is bringing you in right now?

No clinical language needed -just share what feels important.

Limited to 600 characters

What type of support are you looking for?

Individual Psychotherapy Family (Parent-Child) Psychotherapy Professional Consultation Not Sure Yet Other

Have you or your child experienced any of the following?

Currently in therapy Previously in therapy Currently taking psychiatric medication Previously taking psychiatric medication Hospitalized for mental health (recent) Hospitalized for mental health (past) Mood Disorder/Depression Anxiety OCD Grief/Loss Developmental/Relational Trauma PTSD/Complex PTSD Neurodevelopmental Difference (FASD, Autism, ADHD, etc.) Learning differences (ADHD, Dyslexia, etc.) Substance use Disordered Eating/Eating Disorder Suicidality Self-Harm Other None of these apply

Are there any developmental experiences that you feel are relevant to care?

Prenatal Substance Exposure Early Medical Complexity Significant Loss/Greif Adverse Childhood Experiences (ACEs) Frequent Moves/Instability Disrupted Early Attachment Adoption/Foster Care Neglect or abuse history Exposure to domestic violence Medical Trauma Prefer not to say Other Not Applicable

Brief Safety Screening

Currently experiencing thoughts of harming self or others. Experienced thoughts of harming self or other in past. Recent crisis, hospitalization, or significant safety concern ( within past 30 days). Crisis, hospitalization, or significant safety concern (more than 30 days ago). A current safety plan is in place. No current safety concerns.

Is there anything about current family or relationship dynamics you'd like me to know before your first session?

For medical emergencies, contact your healthcare provider or call 911. For mental health crises, call or text 988.

Janessa Nikols, MA., LCPC

312.488.9049 |

Chicago, IL

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THE CLIENT PORTAL IS NOT TO BE USED FOR EMERGENCY SITUATIONS. IF YOU OR OTHERS ARE IN IMMEDIATE DANGER OR EXPERIENCING A MEDICAL EMERGENCY, CALL 911 IMMEDIATELY.