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About
Therapy Focus
Client Concerns
Process
Faq’s
Blog
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Appointment
Counselling Consent Form
Counselling Consent Form
Please fill the form below and read the information carefully.
Client Information:
Name
*
Date of Birth
*
Phone Number
*
Email
*
Emergency contact
Emergency contact’s number
Name of emergency contact
Relationship to client
Purpose and Nature of Counselling
*
Purpose and Nature of Counselling
I, the undersigned client, hereby consent to participate in counselling sessions with Dhanishta Shah. Counselling is a collaborative process that aims to explore and address various personal, emotional, and psychological challenges. The counsellor will provide support, guidance, and understanding throughout the counselling process.
Confidentiality
*
Confidentiality
I understand that all information shared during counselling sessions will be kept strictly confidential, except for specific legal exceptions including but not limited to the following: Exceptions to Confidentiality:
a. If there is a risk of harm to myself or others.
b. If there is any form of child/ elder/person abuse.
c. If there is a court order for the release of information.
Payment Policy
*
Payment Policy
I agree to pay the agreed-upon amount for each session. Payment is made prior to the session or immediately after.
Cancellation policy
*
Cancellation policy
A reminder is sent one day prior to your scheduled appointment. Please note that any last minute cancellations on the day of the appointment are chargeable.
Crisis counselling
*
Crisis counselling
The counselling sessions are designed to provide support, guidance, and assistance for various life challenges and personal growth. They are not suitable for situations that require immediate attention, such as severe mental health crises, imminent danger to oneself or others, or other urgent matters. Please be aware that our response time to communication may not be immediate, as we operate within scheduled appointment hours. If you believe you are in a crisis or need urgent help, it is essential to seek assistance from appropriate professionals who specialist in crisis intervention.
Consent
*
By checking this box, I acknowledge that I have read and understood the information provided in this consent form. I voluntarily consent to participate in counselling with Dhanishta Shah, and I understand the terms and conditions outlined above.
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