This information will only be used in case of an emergency, where it might be needed.
Mental Health Brielfy describe why you gave this score above.
Why are you seeking therapy? Please give as much detail as you can)
Family and Cultural Background (e.g. Origin, number of siblings, parerents)
How woudl you describe your relationship with your family?
If yes, what condition(s) have you been diagnosed with?
What medications are you currently taking?
Therapy Goals and Expectations What experience of counselling or therapy have you had before ( please provide details and duration)
What are your goals and expectations of therapy? ( please list 3 or 4 issues you'd like to work on in sessions)
What is your availability? (select all that apply) * Required
Please tell me your interests and hobbies?
Please provide GP Details
I will only use your GP details when required to do so if I believe you are at harm to yourself or others.
I declare that the information i've provided here is accurate and complete
I allow Oakpath therapy to collect this information for the purpose of our work in accordance with the privacy policy
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