Glenn Harrison Clinical Intake
0%
Confidential · Pre-session ~10 minutes

Confidential · Pre-session

Clinical intake.

For New therapy clients
Time ~10 minutes
Send before Your first session
Stored Securely. Not shared.

Thank you for booking. This intake helps me prepare properly for our first session — saving us both time and giving the work the best possible start.

Take ten minutes when you've got space. Be as honest as you can — there are no wrong answers, and only I will see this. Skip anything that feels too much; we can talk it through in person if you prefer.

Your information is stored securely and handled in line with my Privacy Policy and the Privacy Act 1988.

About you

i. About you

The basics so I can get in touch and keep your records straight.

Best way to reach you
Only if you'd like sessions or correspondence by post — otherwise leave blank.
What brings you in

ii. What brings you in

A few sentences in your own words is plenty. We'll go deeper in person.

If we did good work together, what would be different in your life six months from now?
Have you worked with a therapist or hypnotherapist before?
What worked, what didn't, what you're hoping might be different this time. Optional.
Health and history

iii. Health and history

Anything that might be relevant. Not a complete medical record — just the things that bear on the work.

Diagnoses, chronic conditions, injuries, anything that affects your day-to-day.
Diagnoses, hospitalisations, anything ongoing. Only what you're comfortable sharing.
Are you currently working with a GP, psychologist, or psychiatrist?
Helpful so I know we're not working at cross purposes. Won't be contacted without your consent.
Medications and contraindications

iv. Medications & contraindications

Especially important for massage and hypnotherapy. Some conditions ask us to adjust the work or refer on.

Including dose if you know it, and what each is for. Over-the-counter and herbal too.
Especially relevant if we're using oils or specific aromatherapy.
Any of the following apply? Tick anything relevant — this helps me adapt or refer where needed. Not all are blocks; most just require care.
Skin conditions, recent illness, anything that didn't fit above.
Emergency contact

v. Emergency contact

Standard practice. Used only in an actual emergency — never for routine matters.

Consent

vi. Consent

Each of these is a separate consent. Tick what applies — nothing is pre-ticked, and recording and marketing are optional. You can withdraw any consent at any time.

Required to proceed

Optional

When you submit, this form is sent securely to me. I'll review it before our session and bring any questions in person.