Therapy Intake Form (Children) - Confidential

Therapy Intake Form (Children) - Confidential

To be completed by the client. Please complete the information on this form. These are some of the questions we might ask you during your first session in order to help you achieve your goals better. Completing this form accurately helps reduce the time spent on these questions during your session, so we can focus on other areas. It may seem long, but most of the questions require only a check, so it will go quickly. If you have any questions, please send us a WhatsApp message on 08096642604 and we would respond ASAP.

Please write in details to enable us to have an idea of how to help you efficiently
How would you classify your eating habit? *
How would you classify your sleep? *
Have you ever had feelings or thoughts that you didn't want to live? *
Have you ever had the thought to kill or harm someone else? *
Has anyone in your immediate family died? *
Are you bullied in school? *
Are you bullying anyone in school? *
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