Client Intake Form

Important information you need to provide to your counsellor before your session.

Client Intake Form

Honouring the coexistence of holistic mind-body psychology counselling and the Māori practice of the Tihei-wā Mauri Ora to find meaning, purpose and understanding to heal our collective whānau together

This form is to be completed before attending your first counselling session. If you are not sure about completing this form you are welcome to complete it as part of your first session, however it will reduce the time available for counselling or support.

Please fill and submit this form with as much information as possible, thank you.

Gender

Client Type

Please select any of the following experiences or concerns you may need to discuss

Previous Counselling, Psychologist or Therapy?

12 + 3 =

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