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Assessment Session
Earth Wisdom Ecotherapy Community Interest Company
Assessment Session
Date
*
Client Reference
*
Have you been in therapy before? What was that experience like?
*
Do you have supportive people in your life? If so, who?
*
How is your relationship with your family?
*
Health/Medical Professional/Agencies involved? Including Medication Details.
*
Availability for Sessions.
*
What are the goals you want to accomplish in therapy? What do you expect from therapy?
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Why are you seeking therapy at this time?
*
Is there any risk of harm to self or others?
*
Self-harm
Suicide
Violent Behaviour
Substance Misuse
Domestic Abuse
Mental Health Crisis
Safeguarding of Children
Safeguarding of Adults
None
Other
Counsellor Name
*
Counsellor Surname
*
Signature
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