Counselling Form This counselling form is to be completed before your first appointment. Your detailsName* First Last Date of birth* DD MM YYYY Address* Street Address City ZIP / Postal Code Email* PhoneMore about youOccupation*Nationality*Ethnic origin*First language*What is your availability for appointments?* Preferred method of contact*EmailTelephoneHave you attended counselling/therapy previously?*NoYesYour interest in counsellingWhat areas of your life would you like to work on in counselling? How long have you been concerned about the issue/s mentioned? What prompted you to seek support at this particular moment? What changes would you like to work on in counselling? What do you think your main challenge is to make these changes? What would you like to have achieved at the end of the therapy? Please make any other relevant comments here: Δ
