Client Consent Form
Thank you for choosing us as a support system during this time. Please can you fill out the below to consent to us assisting you further. Feel free to provide the name you would like us to know you as.
Email *
Name *
Country *
Time Zone *
Email address *
Contact Number
Are you over 18? *
Is help required for anyone under the age of 18? *
If you answered yes to the previous question, are you a legal guardian and lawfully entitled to seek assistance for the minor? *
Name of Minor/s
Age of Minor/s
Please give us a short description of how we can help *
I consent to being contacted for assistance *
Please advise your preferred availability
I give consent to a senior member of the GTRC team to sit in on any of my sessions to ensure quality and to provide an additional resource of care? *
Are you involved in any pending or ongoing court cases at all regarding the issues that you'd like help with? *
I understand that my information will be kept confidential, unless discussed otherwise *
I understand that this is not an emergency response center, and if this is an emergency, I will contact emergency services in my area *
I understand that my support will be via the GTRC app and Zoom Meetings, and not on Whatsapp.
Clear selection
I understand that I will be supported by someone who is skilled in their area, and is operating of their own free will as a volunteer. *
I understand that the Global Trauma Response Centre is there to provide only support, but is not accountable for the actions of their volunteers or clients. *
I agree to receive this support offered of my own free will *
What's next?
You will be contacted by a member of our team via email to give you details on how to download our App and also arrange your Zoom call with your specifically chosen Trauma Debriefer. Please check your email (including your spam folder.) You should typically hear from us within 48 working hours. If you have not please feel free to contact us by emailing contact@globaltraumaresponsecentre.online

Should you be unable to receive emails, please follow the below to join our app:

Download the app called DiscourseHub
Add the following link: app.globaltraumaresponsecentre.online/
If you have the option then add it as your homepage on the app.

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