Initial Consultation Form

Before your appointment can be confirmed, this form must be completed and submitted in full. The information provided allows me to prepare appropriately for our first session and ensure that administrative and legal requirements are met. This helps create a safe, structured, and efficient therapeutic process from the very beginning. Appointments can only be scheduled once this form has been reviewed and approved.

First Name

Last Name

Address

Reason for appointment

I confirm that I have read and understood the terms and conditions, including the cancellation policy, as stated on the website and in the appointment confirmation emails. I understand that as this is a one-person private practice, appointment times are reserved exclusively for me and cannot be offered to other clients at short notice. For this reason, if I do not cancel within the stated cancellation window, the full session fee will be charged.

I also understand that payment for the first appointment must be made within the timeframe specified in the confirmation email and before the scheduled session. If payment is not received within this timeframe, the appointment will be cancelled and the session fee will still be charged.

I confirm that all information provided in this form, including my full name and residential address, is complete and accurate. I understand that this information is required for administrative and billing purposes. Providing incorrect or incomplete information may result in the cancellation of the appointment or additional administrative steps.

Thank you!

Initial Consultation Form

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