SILVER LININGS COUNSELLING & PSYCHOTHERAPY

Intake Form

Please could you take some time to fill out the following questions and submit.

You will then be matched to a Therapist on placement and sent the discounted booking link -£25 fixed rate session fee (please check your spam mail).

If you choose to go ahead you can either go with the recommendation or select your own choice if available in the calendar and information provided. All are registered with a governing body.

Due to high demand, limited availability and to be more accessible there is not a consultation for this option however, please email if you have any questions: silver.linings.cp@hotmail.com

Name

First Name

Last Name

Phone

(###)

###

####

D.O.B

Address

Emergency Contact Details

What does an average day look like for you: How is your diet, routine, exercise, sleep? work/study balance?

Do you feel supported by family/friends etc?

How would you describe yourself and what’s Important to you?

Have you ever accessed Therapy before? If yes, what was helpful/unhelpful? How come?

What has prompted you to access support now?

Which branch do you need?

Do you have a a specific day that you need or are you flexible?

How consistent are you hoping to book sessions this time?

Where did you find out about Silver Linings?

Would you like to subscribe to our free monthly newsletter? (Incl: professional prompts, exclusive offers & updates)

Yes