Counselling Questionnaire
Thank you for your interest in our Counselling service! The form below will give you an opportunity to tell us a little bit about yourself and what you hope to achieve during each session with us.

All information provided on this intake form will remain completely confidential. This information is used to determine counsellor suitability and help us tailor our sessions to meet your desired objectives and goals.

Please don't hesitate to email counselling@futurereadyminds.com if you have any questions whatsoever.

Sincerely,

The Future Ready Minds Team

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Email *
Client Contact No.
 *
Primary Emergency Contact (First Name & Last Name) *
Emergency Contact: Phone number *
Clients Address *
Best way to contact me *
Clients name *
What type of session would you like to book? *
Preferred Type of Counselling
 *
Clients age and current grade (if applicable) *
What are your interests, hobbies, and skills? *
How would you describe your technology and screen use? How many hours a day do you engage with screens? What's the typical usage purpose? *
How would describe your nutritional intake? Please provide a general idea of their typical meals, any allergies/intolerances, likes/dislikes. *
How many hours of sleep do you typically get? *
What are your strengths? What skills would you continue to work on? *
What skills are you hoping to focus on and develop during these sessions 1:1 sessions? *
Have you previously received any form of therapy, medication or treatment with regards to your concerns? *
Please tell us what you hope to achieve in our counselling sessions. *
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