Counselling Intake Form

I offer counselling sessions via VIRTUAL VIDEO CALLS worldwide*. These are conducted via a range of end-to-end encrypted platforms, such as Skype, Zoom, and What’s App.

All sessions are 60 minutes in duration.

Initials $152 and Follow-ups $115

WE’LL GET THROUGH THIS counselling is a private billing practice. Payment will be settled via an emailed invoice, once the intake form is processed and your booking is confirmed.

*AEST time ~ please choose a session (which is in AEST) that suits your local time, for those outside of Australia.

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Client Information

Your Name(Required)
Date of Birth(Required)
Employment
Address

Availability (days/times)

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