Name * First Name Last Name Email * Partner's Name * First Name Last Name Have you been to counselling/therapy before? Yes No Is there anything you'd like to share about what’s been happening for you recently that led you to seek counselling? This helps me get a sense of what support might be most helpful right now. Terms * Confidentiality Everything you say in session is confidential. The only exceptions to this are if you are at imminent risk of harm to yourself, imminent risk of harm to other people or by a court subpoena. In those situations I have a legal obligation to report the matter to your GP, next of kin and/or to the appropriate authorities. Cancellation and No Shows If you need to cancel an appointment, please cancel with more than 48 hours notice to avoid a cancellation fee. Where you cancel with less than 48 hours (but more than 24 hours) for a session, you will incur a fee equal to 50% of the session fee. Where you give less than 24 hours notice for cancellation, you will incur a fee equal to 100% of the session fee. An appointment is considered a ‘no-show’ if I have not heard from you and you do not attend within 15 minutes of the start of the appointment. I agree Emergency Contact * First Name Last Name Phone (###) ### #### Thank you!
