Pre-Session Client Information

IMPORTANT: The completion and return of this form confirms that you understand and agree with the Terms and Conditions of Consulting with Pollin Kamell, as listed at the end of this form. A copy will be kept on file.

*** PERSONAL DETAILS AND HISTORY

*** EXPERIENCE AND EXPECTATIONS

Are you here of your own choice?




*** PAST AND CURRENT THERAPY HISTORY

*** MEDICAL AND HEALTH CARE HISTORY

*** MEDICATION DETAILS

*** PERSONAL AND FAMILY BACKGROUND

*** RELIGIOUS OR SPIRITUAL BACKGROUND

*** ADDITIONAL INFORMATION

*** TERMS AND CONDITIONS OF CONSULTATION

I hereby confirm that (please tick each point as you read them)













 

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