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The Wellness Specialist - Specialised Services
Wellness Counselling Services for individuals, couples, families and children
. Our TWS Wellness and Learning Hub is based at Garden on 4th, 68 4th Avenue, Linden, Randburg
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Our offices create a tranquil setting for healing and conversation
The TWS Wellness & Learning Centre is located at Garden on 4th - 68 4th Avenue, Linden, Randburg
First Name of Client Needing Assistance
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Your answer
Last Name of Client needing assistance
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Your answer
Email Address
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Your answer
Contact Number
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Your answer
Who are you filling this form out for?
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Myself
An adult relative/friend
A minor
Address of individual
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Your answer
I understand that if I am filling this form out for a minor that I must be their legal guardian
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Yes
No
Not applicable
Full Name of person completing form
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Your answer
Preferred mode of communication
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Email
Zoom
Whatsapp
Other:
Preferred Mode of Consulting
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On-site: 68 4th Avenue, Linden, Randburg
Virtual (Zoom)
Telephonic (Whatsapp Calls)
Other:
Services required
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Transitional Counselling after major change, loss or chronic/terminal diagnosis
EOL Doula Support due to fatal diagnosis in family preparation, legacy work & related
Transitional Counselling due to traumatic birth experience, miscarriage, termination or related
Postpartum Support after birth, miscarriage, stillbirth, during IVF or adoption
Family readiness - birth, marriage, divorce
Bereavement Support
Parental Support
Advance Care Planning
Wellness & Lifestyle
Play led wellness counselling (children)
Neurodiversity support
School readiness for Grade 1
Career guidance & change
Other:
Required
I consent to The Wellness Specialist contacting me
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Other:
I agree that our consultations are confidential unless I am a danger to myself or others or the request comes from a judge or yourself in writing
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Yes
No
I agree that communication will be done via Whatsapp or sms (09:00 - 14:00) or email and that personal social media pages will not be utilised for communication in order to ensure our relationship is kept professional.
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Yes
No
Required
Costs (Due Prior to Session)
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Counselling - R600 per single session
Counselling - R550 (2 or more sessions)
Family Counselling Session - R750 (90 minutes)
4 session counselling package - R2000 (excl VAT)
6 session counselling package - R3000 (excl VAT)
8 sessions counselling package - R4000 (excl VAT)
10 session counselling package - R5000 (excl VAT)
Please provide a short description of the assistance you need
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Your answer
Please provide me with the outcomes that you wish to reach after our sessions
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Your answer
Please let me know when you would like to begin sessions
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As soon as possible
Next week
In a few months
Next
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