Pre-Therapy Questionnaire

This form is to be completed before your first appointment with your counsellor.
To maintain confidentiality, you are required to enter the identification number issued to you by the Counselling Centre. Do not enter your name anywhere on this form.

Once you have submitted the form, the Counselling Centre will then pass on this information to your counsellor in readiness for your first appointment.

If you are using a mobile phone to access this page, you may see a Microsoft forms box, you will need to click the link “Fill in the form” in order to continue.