Appointment Intake FORM

Hello, thank you for your interest in making an appointment to see me for counselling.
It is very important to me that you receive support appropriate to your situation.
To help determine this, please read the following information carefully. 

This appointment must be for the person making it or, with the agreement of your partner
if you are attending as a couple.I can only support clients over the age of 18 yrs.

Relationship/couple counselling, may not be appropriate if ‘Intimate Partner Violence’ (Domestic Violence) is present in the relationship. If this is the case, expert support may be required.

As I am not an expert in this area, I am unable to assist in these circumstances.
If your GP has given you a Mental Health Care Plan (MHCP)
you will be unable to use this if you wish to see me for counselling.

If you want to use a MHCP you will need to contact a ‘Psychologist’.

Some people may still choose to see me,
if they prefer to keep their attendance at counselling private,
or if they do not want to go on a waiting list to see a psychologist.

I cannot provide crisis or emergency mental health support.
Please attend your nearest hospital emergency department or contact one
of the organistaions mentioned below.

Lifeline: 13 11 14
Suicide call back service:
1300 659 467
Crisis Care: 1800 199 008
Mental Health Emergency Response Line: 1300 555 788

Please tick below if you accept and understand the above information and have read the
Cancellation Policy below and wish to continue with your booking,

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Please Read the Cancellation Policy