FEL Student Intake Form

Name*

First NameLast Name

Email*

example@example.com

Mobile Number*

Country CodeArea CodePhone Number

Landline Number

Country CodeArea CodePhone Number

Address*

Street Address

Street Address Line 2

CityState

Zip CodeCountry

How did you hear about this program?*

Occupation*

Please list your current qualifications*

Why are you wanting to complete this certification?*

If Other, please explain:*

Please provide some details around why you'd like to participate in this program*

What are the goals you would like to obtain by being part of the FEL program?*

Confidentiality:

With limited exceptions, information provided to Fabic staff will be kept confidential by the Fabic team, meaning information will not be discussed with outside parties without your written permission. The exceptions to this rule are related to professional, ethical and legal obligations. Specifically, information is required to be disclosed to relevant parties or authorities if:

The clinician identifies the potential for immediate and specified risk of harm to yourself or someone else
The clinician identifies risk of child abuse
An enquiry is made by a legal guardian if you are not your own legal guardian
If information is legitimately subpoenaed by a court or otherwise authorised for release by law (as it is important to note that psychological records have no special legal privilege).

Appointment duration:

All standard appointments run for 50 minutes. If you run late for an appointment, the appointment duration will be reduced but this does not adjust the fee that you have been quoted for your appointment.

Fees:

* All fees are quoted in Australian Dollars

Current associated pricing for learning materials, group and individual supervision can be found on Fabic sister sites:

fabic.education
fabic.com.au
fabic.tv
fabic.study
fabicpublishing.com

Cancellation Policy:

Individual Supervision:

FABIC requires 2 business days notice of any cancellations. If you are unable to attend a scheduled appointment and notify Fabic with less then 2 business days notices, falls within you incur a full price cancellation fee.

Group Supervision:

All group supervisions have a maximum of 10 people. Attendance requires you to book and pay online and your booking is finalised upon receipt of payment. No refunds after booking, so please ensure you book carefully.

FABIC Products

All products, FABIC.TV, FABIC.Study are non-refundable once purchased

Terms & Conditions
Please note payment of invoices is COD. If a debt collection agency needs to be engaged by FABIC to collect the non-payment of an invoice, an additional 20% administration fee will be added to the invoice and becomes due and payable.

Are you your own legal gaurdian?*

YesNo

If no, please provide details (name and contacts) of your legal guardian and have them sign below:*

I agree to the terms & conditions above

Date*

Date

Signature*