Counselling Request Form - Safe Now Therapy
Hi! Thankyou for considering counselling with 'Safe Now Therapy'! ✨
Please complete the following questions to the best of your ability and I will be in touch to chat about your enquiry 
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Email *
Name *
Preferred pronouns 
Phone number  *
Date of Birth
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/
DD
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YYYY
Have you been in counselling before?  *
What is your availability for sessions?  *
Tell me a little about why you're seeking counselling  *
Are you an NDIS participant or representing an NDIS participant? 
Is there anything else that you would like to share with me? 
Curious, how did you find 'Safe Now Therapy'? 
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A copy of your responses will be emailed to the address you provided.
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