Client Intake Form Page | Soul Shine Wellness

CLIENT INTAKE FORM

Soul Shine Wellness

Welcome! Thank you for choosing Soul Shine Wellness for your counselling journey.

Please complete this intake form so I can better assist you, understand your needs and prepare for your first session. All information is kept confidential in accordance with the terms outlined in your Consent Agreement.

If you have any questions, feel free to reach out before submitting.

First name

Last name

Email

Phone

Birthday

Year

Month

Day

Emergency Contact (Name, Phone, Relationship)

What brings you to counselling?

What are your goals for counselling?

Have you attended counselling before?

Anything else you'd like to share? (Optional)