Client Details and Terms and Conditions

If you have scheduled your first appointment with me, then please read through the Terms and Conditions and fill out the following form.

Should you prefer to fill in a paper copy or email these directly to me, then please let me know.

Please tick below to confirm you have read our Terms and Conditions linked here and then fill in the remainder of your details.

Full Name

Phone Number (Mob)

Phone Number (Home)

Address

Dr's Name and Surgery Address

Emergency Contact Name and Relationship

Emergency ContactPhone Number (Mob)

Any other details you feel will be relevant

To confirm your first appointment I will send you an invoice with bank details so you can make a bank transfer for the session amount. If you have any questions or queries, then please contact me directly.

Find The Way Counselling

Client Details and Terms and Conditions