Riverbank Counselling New Client Form
Congratulations on taking this step towards reaching out for help. Much of the suffering we experience can be really eased through counselling.

As I am only taking a limited number of new clients I want to make extra sure from the start that I am the best fit for you. After reviewing this form I will email you letting you know if I can take you on as a new client.
Email *
What is your name? *
Which age group do you fit into? *
Please briefly describe what you want to talk about. *
What are you most looking for in a counsellor? *
Is there anything else you think would be important or helpful for me to know about?
Do you have any questions for me?
Was I recommended to you by another person? Please let me know who.
Please confirm that you understand the following: *
Required
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