Client Information Form Please enable JavaScript in your browser to complete this form.Face to Face / Online *Face to FaceOnlineDate of Birth *Name *City / State *Phone *Can we leave a message on this number? *YesNoEmail *Can we send an e-mail to this address? *YesNoAre you currently working? *YesNoPlease share your important health information (such as surgery, important diseases) *Please tick the areas where you think you are having difficulties at the moment. *Alcohol / DrugFamily Relations / Parents / ChildrenAnxiety / Concern / FearFriend RelationsBody PerceptionSexual ProblemsSexual Harassment / AbuseDepressionYour Economic StatusDisabilityMarriage / PartnerPhysical AilmentsPhysical ViolencePregnancyRelationship ConcernsSuicidal ThoughtsCareerConcentrationAnger / IrritabilityRomantic RelationshipsVerbal / Emotional ViolenceStressTraumaSleep Problems / NightmaresLonelinessMourning / LostEating / AppetiteOtherWhat are your expectations from therapy? *Name (PERSON TO CALL IN AN EMERGENCY) *Phone (PERSON TO CALL IN AN EMERGENCY) *Approve *I was informed about my rights, responsibilities as a client and the responsibilities of the therapist. I agree to receive therapy and the conditions contained in the form.This form has been prepared to inform you about the therapy process and our general rules. Psychotherapy sessions in our center are 50 minutes. Appointments will be made on the day and time that suits you. If you wish, you can fix your sessions to the same day and time. Talk to your therapist to determine how often you come to therapy and how long you need to come to therapy. Security The therapy process is based on confidentiality. What is said in the interviews will remain between you and your therapist and will not be shared with anyone else. However, in case of a situation that poses a threat to yourself or someone else, your therapist will have to inform the necessary people in accordance with ethical rules. You can discuss this with your therapist. Alcohol and Substance Use You should not attend the sessions while under the influence of alcohol and various substances. While under the influence of these substances, therapy is unlikely to be beneficial. If you have a problem with alcohol and substance use, you can talk to your therapist. Cancellation Rules and Holidays It is very important for your therapy process that you attend the sessions regularly and ensure continuity. Of course, there may be problems that make this difficult, but the important thing is to talk about these problems with your therapist. In cases where the sessions are late, it will not be possible to extend the session or make up for the lost time. If you are more than 20 minutes late for the sessions, your session will be cancelled. If you wish to cancel or postpone your scheduled session, you must notify us 24 hours in advance. In case of cancellation of an appointment on the same day or failure to come to an appointment without notice, you will have to pay the fee for the call you did not attend. Likewise, if your therapist cancels your session on the same day, they will provide you with a free session. For cancellations and changes, you can contact us at 0536 571 98 81.Submit