To reduce the amount of paperwork you must complete on your first visit, we would appreciate it if you could complete our registration form.  Before proceeding, if you would want to get in touch with us, we would be delighted to speak.

Client Form - Relationship - Family

DD slash MM slash YYYY
Sessions(Required)
Name(Required)
Address(Required)
DD slash MM slash YYYY
Gender(Required)
Does the client identify as:(Required)
Is an interpreter required?(Required)
Does the client have a disability?(Required)
Are there any safety issues to be considered?(Required)

Additional Client Details

Name:(Required)
Address(Required)
DD slash MM slash YYYY
Gender(Required)
Does the client identify as:(Required)
Is an interpreter required?(Required)
Does the client have a disability?(Required)
Are there any safety issues to be considered?(Required)

Emergency Contact Details:

Name(Required)

Counselling/Art Therapy Requirements

Please give some details on why you want to see us so we can assign you to suitable Therapist.

Invoicing Details

Name(Required)