Intake Form

This information is used to understand your needs and to support your assessment.

Information is ONLY shared with the therapist who you have booked (or will book) your therapy with, and not shared with other people or agencias without your consent.

However, therapists (and health professionals) are obliged by law to protect you and the public, so there may be some situations that information needs to be shared.

If, or when, information needs to be shared you will be informed and only the relevant information will be shared.

MM slash DD slash YYYY
I consent and agree to Mental Health Assessment/Treatment(Required)
I agree for this form to be sent to the Associated Therapist(Required)
Check terms and condition(Required)