Thank you for your interest in Support Services through In Katharsis.

This form helps me gather the information needed to understand needs, goals, and preferences, and to determine suitability, availability, and next steps.

Please complete it with as much detail as you can.

Privacy and confidentiality
All information provided is treated respectfully and kept confidential. It is used only to respond to this enquiry and, if appropriate, to plan and deliver supports. Information will not be shared without consent, except where required by law.

Please note: submitting this form is an intake request only, not a confirmed service booking. I will be in touch after review.

Note: I provide non-clinical community access and social support only.

Thank you for taking the time to complete this intake form. I appreciate the information you have shared.

I will review the information provided and contact you as soon as possible to discuss suitability, availability, and next steps.

Please note: submitting this form is an enquiry only.  It does not confirm a booking or service.

By submitting this form you give consent for me to contact your support coordinator, if one has been listed, as part of the intake process.

By sumbitting this form, you are confirming the details you have provided are true and correct to the best of your knowledge.

 

Thankyou, Eliesha