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New Client Intake

This registration form is required following consultation and agreement to commence with treatment through Adam C Therapy. If you have not yet arranged an appointment, you can get in contact .

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If there are any any concerns about the content or details within this registration, please get in touch to discuss these. 

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I appreciate that page 2 in particular has got lots of information on it - The intention of this is to set out a safe understanding of the therapeutic relationship. 

New Client Registration Form (Page 1/3)

This registration is made up of 3 parts - This page is about you and your contact details including next of kin. The 2nd part is the Therapeutic Agreement that you are required to sign at the bottom of the page. The last part is the GDPR notice that gives you your rights about your data that you are also required to sign.

Birthday
Day
Month
Year
Multi-line address

Next of Kin

Only to be contacted in event of emergency

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