Mike Lubofsky, Licensed Psychotherapist and Attorney

Psychotherapy for Individuals and Couples

Phone:
415-508-6263

Request Appointment



Client Wellness Check-in

Please use this form as a prompt to briefly retreat from the busyness of life and report on how you have been doing over the past 24 hours.

Name(Required)
Considering the past 24 hours, how pleased are you with your level of self-care (e.g., diet, exercise, sleep, enjoyable activity, meditation, etc.)(Required)
Considering the past 24 hours, how would you evaluate your relationship to drugs, alcohol, and/or other addictive behaviors?(Required)
Overall, if you set an intention for today, do you feel that you lived up to that intention today?