Email Counselling Booking Form - New Clients

It is preferred that you used an encrypted email address to protect your privacy and data. A free Protonmail or Hushmail email account would be ideal.

Suitability for Email Counselling

Please note that email counselling may not be suitable for all people. If you are experiencing interpersonal violence of any kind (whether physical, emotional, sexual, spiritual or financial), please reach out by phone on 0411 889 175 and alternative arrangements will be made to ensure you get the help you need. Similarly, if you are having any thoughts of self-harm or significant mental health challenges, email counselling may not be suitable for you. I encourage you to contact me on 0411 889 175 or by email so alternative arrangments can be made.

Informed Consent

If you decide to proceed with email counselling, I ask you to read, sign and submit the counselling agreement, which you will be directed to after submitting this form. This is an important step in clarifying that you understand the arrangments for email counselling. It is important to me because I value your right to give informed consent to receive email counselling.

Intake Form for New Clients

To assist me in providing you with effective email counselling, the following information is appreciated.
In the last 4 weeks, about how often did you feel:

How many sessions would you like to book?

Up to approximately 1000 words per email

Payment:

Once you submit this booking form, you will be provided with your 'next steps' to get started with email counselling.

Not Quite Ready Yet?

You are welcome to book a free inquiry call to find out if we are a good match

Pin It on Pinterest