Kids & Teens Intake Form | NALA
17377
page-template-default,page,page-id-17377,ajax_fade,page_not_loaded,,vertical_menu_enabled, vertical_menu_transparency vertical_menu_transparency_on,no_animation_on_touch,qode-title-hidden,side_area_uncovered_from_content,qode-child-theme-ver-1.0.0,qode-theme-ver-16.8,qode-theme-bridge,disabled_footer_bottom,qode_header_in_grid,wpb-js-composer js-comp-ver-6.6.0,vc_responsive
NALA

Kids & Teens Intake Form

e.g he/him, she/her, they/them

Parent/Gardian Details

Please be aware that if there is a custody arrangement in place both parents consent is required for the sessions to go ahead. If the second parent's consent is unable to be obtained please call us to discuss options.

Reason For Counselling

Please include as much detail as possible.

General Information

If you nominate availability for a morning and/or Telehealth appointment you are more likely to secure an appointment sooner.

Policies

Cancellation - We ask that clients contact the clinic no later than 11am of the previous business day if you are unable to attend, please cancel at your earliest opportunity via phone, text or email so that the appointment can be made available to others. In the event you don’t, a 100% cancellation fee will be incurred. This policy is explained during intake and at the initial appointment with your psychologist.