Client registration form - Family Therapy
On line or in person for you and your family to work with a therapist to explore your family relationship. Therapy gives you a space to express your fears and concerns, to ‘hear’ each other and learn new ways to communicate as a family.
Please complete our form below, this will give us all the information we need to arrange your first appointment. You will be asked to pay an amount for each session, normally a minimum of £40 and a maximum of £80 and based upon your household income and using the scale on the form, . Please ask about costs at your first appointment and the amount you feel you can contribute.
Please note that we need all parties attending to complete a form separately for our GDPR regulations. Failing to complete a form will hold up your appointments. Please also indicate your partner’s name on your own form so that we can link these. All young people attending and aged over 14 should complete their own form here.
We understand this is a long form to complete however we will only ask you for this information once. Please call us on 0131 556 1527 if you would like support to complete the form.
Gift Aid
Please consider completing the Gift Aid section at the end of this form. If you’re a UK taxpayer, you can make your counselling contribution worth 25% more, at no extra cost to you. For every £1 you contribute we will receive an extra 25p from HMRC.
Please read our Counselling agreements and contract for clients before submitting your form.
