Assessment Form

If the client has a diagnosis, indicate here.
If the client is currently taking any medication, complete details here.
Indicate here the client's level of risk to self or others.
Type of Therapy
Indicate here the type of therapy requested by the client.
Gender of Counsellor
Indicate here whether the client prefers a male or female therapist.
Indicate here the client's availability for counselling.
Locations
Indicate here the client's fee according to their employment status.
Indicate here any further comments, or requests made by the client.