Client Intake Form: Talking Therapies

Contact details of the client, or parent/guardian if the client is aged 16 or younger.

All the fields below are required to submit this form. If any fields do not apply to you/are not relevant, please type “none” or “N/A”.

Electronic Signature: You can complete the box below which we will accept as your e-signature. If you would prefer, you can download this form here and either digitally sign it, or print, sign and scan/photograph it and email it to us at