Case Manager
Client Details
Gender
Do you consider yourself disabled?
If, yes please indicate the nature of your impairment
Contact Details
Permission for voicemails to be left on your telephone
Permission for voicemails to be left on Mobile Please state Yes or No
Do you give permission to receiving text message reminders prior to your appointments?
Is an interpreter required?
Referrer
Common life problems
Common mental health problems
Complex Mental Health Problems
I confirm I have the consent of the individual/family referred above

Third-Party Disclaimer

As our client, the information you share in counselling sessions is kept confidential. However, if you are being referred by a third party, we may need to share certain details with them in accordance with your consent and our professional ethics.

Honesty and Accuracy

For the counselling process to be effective, it is important that you provide honest and accurate information to your therapist. This ensures the best possible support and outcomes.