Holistic counselling client intake form

Welcome to Flow From Grace. This intake form is designed to help us understand your unique journey and needs in holistic counselling.

This form has five sections and takes about 15-20 minutes to complete. Take your time; this is a space just for you.

Question 1

Clients DetailsThis question is required.

Please fill in the following information to help us understand your unique needs and provide the best support possible. Your details are confidential and will only be used to enhance your experience with us.

Full Name

Preferred Name

Contact Number

Mailing Address

Occupational Status (if relevant)

Marital Status (if relevant)

Referral Information (if relevant)

Usual Doctor

Medical History (Please share any relevant information that may support your wellbeing in our sessions. This section is optional.)

Private Health Care Fund Information

Health Care Pension Information

Emergency Contact (Only used in case of an emergency.)