Onboarding Form

This form is for clients I have agreed to work with. Please complete it only if you have been asked to.

Now might be a good time to grab a cup of tea and set aside 20 minutes in a quiet place where you won’t be disturbed. You may find it easier to do this on a device bigger than a phone.

The form is designed to capture the information necessary for me to carry out my role as a therapist.

Submitted forms are stored securely and are anonymised.

Onboarding Form: Only submit this if you have been asked to.

Please enable JavaScript in your browser to complete this form.
Name
Must be over 18
Do I have your consent to contact your GP if necessary?
Next of Kin Name
Who is the next of kin to you?
Do I have your consent to contact your Next of Kin if necessary.
Have you had counselling/therapy before?
Are you currently feeling suicidal?
If yes, have you made plans about how you would end your life?
Do you understand that therapy is not an alternative to immediate mental health care from GP, Hospital or Emergency Services?
If you are currently planning on taking your own life, you must approach your GP, hospital, or emergency services. If you feel that you cannot obtain that help yourself, get someone to call for help on your behalf.
Please check this box to give consent to me holding your data under GDPR.