Counselling Intake Form

    To schedule an appointment, kindly complete the form below.

  • Informed Consent

    By submitting this form you agree that you are fully aware of the following:

  • Intern Counsellors

    This counselling unit also receives free support from Intern Counselors, Psychotherapists and Psychologists. Should you require a higher level therapy, or skilled counselors, please indicate your budget and we will assign a therapist accordingly.

  • Confidentiality

    You agree and understand that all interactions with your counsellor, including content of your sessions, progress in counselling and your records are kept strictly confidential. However, you are also aware of the exceptions to confidentiality. Disclosures of information pertaining to your counselling sessions, to a third party is deemed necessary in the following circumstances:

  • 1) Supervision

    The counselling staff in this centre works as a team. Your counsellor may consult with other counselling staff to provide best possible care. These consultations are for professional and supervision purposes only.

  • 2) Imminent Danger & Harm

    If there is evidence of clear and imminent danger or harm to you and / or others, your counsellor is legally required to report this information to the authorities to ensure your safety and the safety of others.

  • 3) Abuse & Neglect

    The Singapore law requires the staff who learns of or strongly suspects that, physical or sexual abuse, or neglect of a child or elderly, to report this information to the authorities.

  • 4) Legal Mandate

    When there is a court order, issued by a judge, requiring release of client information contained in records, and / or requires your counsellor to testify in a court hearing.

  • In the best of your counsellor's ability, your counsellor would keep you informed, before consulting others or disclosing your information to any third party.

Report Abuse