Child/Teen (17yo and under) Individual Therapy Enquiry Form

Client Name

Address

Parent/Guardian 1

Parent/Guardian 2

Cancellation - We ask that clients contact the clinic no later than 48 hrs before your appointment if you are unable to attend, please cancel at your earliest opportunity via phone, text or email so that the appointment can be made available to others. In the event you don’t, a cancellation fee will be incurred. This policy is explained during intake and at the initial appointment with your psychologist.