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New Client Intake Form

New Client Intake Form
Wynning Counselling

WYNNING COUNSELLING

Guiding you foward

New Client Intake Form

Welcome

Thank you for choosing Wynning Counselling. Please complete this form before your first appointment. The information you provide is confidential and will help us understand your needs and provide the best possible care.

Personal Information

Emergency Contact

General Practitioner (GP)

Presenting Concerns

Mental Health History

Medical Information

Lifestyle and Wellbeing

Alcohol and Drug Use (Optional)

Safety

Consent

I understand that:

  • Counselling is a collaborative process.
  • My information will remain confidential except where disclosure is required or permitted by law, including situations involving serious risk of harm or other legal obligations.
  • I have had the opportunity to ask questions about the counselling process.
  • I consent to receive counselling services from Wynning Counselling.