Savvy Counselling & Consulting intake form

Preferred Pronoun
Contact Preference
If we call you can we leave a message?
Have you received any previous counselling or therapy?
Service required
Have you received any prior mental health diagnosis(es)?
Presenting reasons for counselling (please tick)
1) In the last four weeks how often did you feel tired out for no good reason?
2) In the last four weeks about how often did you feel nervous?
3) In the last four weeks about how often did you feel so nervous that nothing could calm you down?
4) In the last four weeks about how often did you feel hopeless?
5) In the last four weeks about how often did you feel restless or fidgety?
6) In the last four weeks about how often did you feel so restless you could not sit still?
7) In the last four weeks about how often did you feel depressed?
8) In the last four weeks about how often did you feel that everything was an effort?
9) In the last four weeks about how often did you feel so sad that nothing could cheer you up?
10) In the last four weeks about how often did you feel worthless?
Have you read and agree to our Terms of Service - Privacy Policy- Cancellation Policy- and Complaints Policy?
Note:By booking and receiving services from Savvy Counselling & Consulting, you are confirming to have read, understood, and agree to our Terms of Service, Privacy Policy, Cancellation Policy, and Complaints Policy. These can be found on our website at savvycounselling.com.au