• Client Information Sheet

    Client Information Sheet

    By completing this form, you (client) are giving permission for your information to be shared within Vanquish Therapies for the purpose of matching you with the appropriate Counsellor, for appointment scheduling, and in the event of an emergency. If you are submitting this form on behalf of another person, please provide your own contact details in the referral section below. By signing this form, you are verifying that you have obtained the client's consent to disclose their personal information to us.
    • Personal Information - (Please be advised that all required fields must be completed in the form. Failure to do so may result in an error. Therefore, it is crucial that you carefully review the form and provide accurate and complete information to avoid any issues. For any fields that do not apply to you, please enter "N/A.") 

    • We primarily communicate through Emails and Whatsapp.

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    • Referral (Please fill out the form below. For any fields that are not applicable, please enter N/A). 
    • Areas You Require Support With. 

    • We're almost there! 😊 Just one more step, and you’ll be able to book your consultation.

    • Assessment 

    • Important - Please read this information before you start completing the below section:

      This section has 34 statements about how you have been over the last week. 

      Please ensure you read each statement and think about how often you have felt that way over the last week. Then tick the box that relates closest to how you have felt.

      This core 34 has been taken from The CORE System Trust:
      http://www.coresystemtrust.org.uk/copyright.pdf

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    • Thank you for answering all of the above statements, please proceed with booking your consultation on the next page.

    • Consultation Payment & Acknowledgement 
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      • Terms & Conditions  

      • We understand that unforeseen circumstances may arise. However, please be aware; Due to limited availability, missing more than one session or failing to book sessions for a week or more, without prior communication, may result in the release of your reserved space with your assigned Counsellor to accommodate other individuals in need of help and support.

      • By submitting this form, you understand and acknowledge that if you miss more than one session or fail to book sessions for a week or more, without communication, your reserved space will be released to benefit someone else who may need it.

      • Thank you for completing this form and for taking the first step towards healing. We understand that starting counselling can feel daunting but please know, Vanquish Therapies is here to support you on your journey, and we are committed to providing a supportive environment for you. Please note – Vanquish Therapies and our online counselling are not a crisis or emergency service. If you need to speak to someone immediately, please contact your GP, NHS (111),or the Samaritans (116 123).

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