Every Day Alchemy

Every Day Alchemy

Holistic Counselling
Mitchell Gravatt

ABN: 76420225158
New Client Intake Form
Name*

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Have you ever been diagnosed with a mental and/or psychiatric condition? If yes, detail below.
Are you currently taking any prescribed medication? If yes, detail below.
What is the primary reason for seeking out this service?
What are you hoping to gain from your session/s?
Have you previously engaged in therapy or counselling? If yes, what was your experience like?
Do you have any specific needs that should be considered for your session/s? If yes, detail below.
Is there anything else that you feel is important for me to know? Please share below.
How did you hear about this service?

Terms and Conditions
Service Provision

The Practitioner will provide a professional holistic health and wellness service, using a range of modalities including but not limited to holistic counselling, coaching, meditation and mindfulness practices, and intuitive energy healing.

The services comply with Australian legal and ethical standards.

Client Responsibilities

By engaging with this services, you agree to:

Provide accurate personal and medical information and provide relevant updates to this information if changes occur.

Comply with all listed Terms and Conditions.

Engage in a manner that is honest and respectful.

Fees and Payment

Cost of the available services will be communicated by the practitioner via email and are subject to change at the practitioners discretion.

An invoice will be sent to the client via email once the booking has been scheduled and confirmed.

The associated invoice must be paid in full at least 24 hours prior to the booked session time. e.g. If you have a session booked on the 10th of November at 2:00pm you must have paid the associated invoice in full before 2:00pm on the 9th of November.

A screenshot of payment is required to be sent to the practitioner via email once the invoive has been paid.

If the invoice has not been paid by the required time, the practitioner will cancel the session and may offer to reschedule for a new available date and time.

Payments must be made via direct deposit to the banking details listed on the associated invoice.

This service is not eligible for Medicare rebates.

Cancellation and Refund Policy

If the client needs to reschedule an appointment, this must take place no later than 24 hours prior to the date and time of the session. If the client fails to reschedule a session with more than 24 hours notice, the session must be paid in full (except in exceptional circumstances).

The sessions are non-refundable. In the event that a client has paid for the session and changes their mind, the above cancellation and rescheduling conditions will apply. Please be mindful of this while booking your session and before paying your invoice.

The practitioner reserves the right to terminate a session at any point if they feel the circumstances require them to do so. In the event that this occurs, the session cost will not be refunded (except in exceptional circumstances).

Confidentiality and Privacy

All client information is kept confidential in compliance with the Privacy Act 1988 (Cth).

Information will only be shared with your consent, except where required by law under mandatory reporting guidelines (e.g., risk of harm, court orders).

Outcomes

While the practitioner aims to achieve positive outcomes for all clients in the form of growth, healing, and personal transformation, no specific results or outcomes can be promised or guaranteed.

Limitation of Liability

The practitioner is not certified to diagnose and/or treat medical or psychiatric conditions and will not attempt to do so.

The practitioner is not responsible for any loss or damage arising from the use of these services, except where required by law.

Functional Considerations

Sessions are run online over Zoom.

By choosing to engage in sessions clients acknowledge that there can be technical limitations and/or interruptions due to power outages or breaks in internet connection.

The client must ensure they are in a private and secure area for the duration of their session with no other persons present and not while out in public.

The client is required to have access to a secure/stable internet connection, a laptop or desktop computer with a webcam and microphone or headphones.

If you are joining the session from a mobile phone, please ensure that your phone is sufficiently charged and is placed on a stable surface for the duration of the session and that at least your head/face is visible in the camera.

Emergencies

These services are not intended for crisis situations. If you are in immediate danger, please call 000 or contact a crisis support service such as Lifeline (13 11 14).

Changes to Terms and Conditions

The practitioner may update these Terms and Conditions at their own discretion and as required. Continued use of these services indicates acceptance of any revised terms.

Client Consent and Agreement
The provision of this professional service is designed as a supportive tool to assist clients in working towards their personal goals. It is not intended to replace medical or psychological care. Clients with a medical or psychological condition must seek professional medical advice, as it is their responsibility to disclose such conditions. The practitioner’s role is not to diagnose.

If a client requires specialised care, the practitioner may refer them to appropriate services or professionals that best meet their needs.

The practitioner’s role is to help clients achieve balance in all aspects of their lives—mind, body, and spirit—while ensuring they remain attuned to their own needs. The practitioner does not assume responsibility for the client’s decisions or outcomes but instead facilitates autonomy by empowering clients to take charge of their own choices and changes. Clients are considered the experts in their own lives and are ultimately responsible for implementing the changes they seek.

All information provided by clients is treated as confidential. Clients have the right to access their personal records, which will be securely stored for seven (7) years from their last contact with the service. Personal details will not be shared with third parties without the client’s consent unless the practitioner believes the client or someone associated with them is in a serious or life-threatening situation. In such cases, the practitioner is obligated to report concerns to the relevant authorities. This may include instances of suicidal ideation or attempts, child abuse or neglect, or physical, mental, or emotional abuse involving the client. If a court of law or third party requests client information, the client will be informed immediately.

As a mandatory reporter, the practitioner is legally required to report any concerns regarding the welfare or safety of the client or others as necessary.

If a client experiences an emergency between sessions, they must contact the appropriate emergency services. In a life-threatening situation, they must call 000 immediately.
By signing this form you agree to the above, acknowledge and accept your rights and responsibilities, accept the listed Terms and Conditions and give your consent to engage with the practitioner. *
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Mitchell Gravatt

New Client Intake Form

Terms and Conditions

Client Consent and Agreement