New Client Informed Consent
Hello and Welcome,

I am Leigh Fraser-Gray, an Accredited Mental Health Social Worker, now operating in clinical private practice.

At the Centre of my Practice are the core values of inclusion, respect, and curiosity, creating a safe space where you can be at ease to explore, consider, grow, and address the issues that are most important to you.

This form confidentially collects personal information that helps me to initially outline your requirements and direct needs before our session/s.
All information is held securely in encrypted, password protected formats that only I can access. If you have queries or concerns about your private and confidential information, please email lfrasergray@gmail.com

This document seems long at first, but please know it forms the foundation of our work together, outlining your rights and responsibilities, including:
1) New Client Information
2) Care Plan Identification;
3) Privacy and Confidentiality Statements; including
- Duty of Care / Personal Safety Clause;
- Suggestions, Compliments, Complaints Process;

If you encounter any barriers to completing the form or have residual questions or queries, we can go through the form during our first appointment together. Just complete and lodge what you can and we can review together when we meet for the first time. Easy peasy!

Please contact Leigh on lfrasergray@gmail.com for more information.

I look forward to meeting with you and sharing your path of discovery.


Kind Regards, And Talk Soon!
Leigh Fraser-Gray
Accredited Mental Health Social Worker
0424 582 878
Sign in to Google to save your progress. Learn more
Email *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ferrets Net. Report Abuse