Assessment Form


Counselling & Psychotherapy Assessment Form

We use this form to learn a little about you and the problem you are bringing to counselling or psychotherapy. We have found it saves a great deal of time when it comes to a first session and prevents us from having subject you to a stream of questions at a time when perhaps nervousness prevents you from thinking straight!

Although its length may appear a little daunting, we have tried to keep things as simple as possible. Please answer all questions as fully as possible. We will respond to your submission within 48 hours.

If you have any questions about our services, please contact us here.

Note: We will not normally contact this individual and will only do so if we assess you as being at serious risk. In the unlikely event that we need to contact him/her, we will only do so on a "need to know basis" and wherever possible, in consultation with you.
(If you are caring informally, as a volunteer or are formally recognised as a carer, please answer Yes to this question. If you offer care as an employee, please answer No. )
Note: It is important that we know about all substances which might have an effect on your mood both during and outside sessions. All information provided here is held confidentially.
Note: It is important that we know about all substances which might have an effect on your mood both during and outside sessions. All information provided here is held confidentially.
Note: It is important that we know about all substances which might have an effect on your mood both during and outside sessions. All information provided here is held confidentially.
Note: It is important that we know about all substances which might have an effect on your mood both during and outside sessions. All information provided here is held confidentially.
If you are over 14 years, but under 18 years of age, you may not accept our Terms and Conditions. However, your parent or legal guardian may accept them on your behalf. If this is the case, your parent or guardian should enter his or her name in the box above, together with an indication of his or her relationship to you.