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Have you ever or are you currently struggling with a dependency with alcohol or drugs - YES or NO*

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SELF REFERRAL FORM

You’ll need to complete this form before your first full session to help us make the most of our time together. It provides important background information, including your reasons for seeking therapy and any safeguarding details I need to be aware of.

If you’d prefer to go through the form during our first session, that’s absolutely fine - just let me know. However, completing it in advance allows us to focus more on you and what you want to work on from the very first session.

SELF REFERRAL FORM

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