JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
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. We also offer online sessions for individuals, couples, families and this extended to children and teens as well.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
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
*
Your answer
Last Name of Client needing assistance
*
Your answer
Email Address
*
Your answer
Contact Number
*
Your answer
Who are you filling this form out for?
*
Myself
An adult relative/friend
A minor
Address of individual
*
Your answer
I understand that if I am filling this form out for a minor that I must be their legal guardian
*
Yes
No
Not applicable
Full Name of person completing form
*
Your answer
Preferred mode of communication
*
Email
Zoom
Whatsapp
Other:
Preferred Mode of Consulting
*
On-site: 68 4th Avenue, Linden, Randburg
Virtual (Zoom)
Telephonic (Whatsapp Calls)
Other:
Services required
*
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
*
Yes
No
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
*
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.
*
Yes
No
Required
Costs (Due Prior to Session)
*
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)
May Promotion - Mental Health Month - Donation basis (cash donation of your choice)
Please provide a short description of the assistance you need
*
Your answer
Please provide me with the outcomes that you wish to reach after our sessions
*
Your answer
Please let me know when you would like to begin sessions
*
As soon as possible
Next week
In a few months
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms