Preferred Name (If Different)
Preferred Method of Contact*
This information is only used if it becomes necessary in exceptional circumstances.
What has brought you to Vocal Psychotherapy at this point in your life?*
What are you hoping to gain from therapy?*
What was it about Vocal Psychotherapy that made you feel it might be the right approach for
you?*
Is there anything about your voice, emotional life or current circumstances that has led you to
seek therapy now?*
Previous Support & Wellbeing Have you previously attended counselling, psychotherapy or another form of psychological
therapy?*
If yes, please tell me anything that would be helpful for me to know.
Have you ever received a diagnosis or support relating to your emotional or mental
wellbeing? (Optional)
Are you currently taking any medication that you feel may be relevant? (Optional)
Is there anything about your physical health, breathing or voice that it would be helpful for
me to know?
Is there anything else you would like me to know before we arrange our first meeting?
How did you hear about Inscape Therapies?*
Preferred Days/Times for Appointments*
Information provided on this form will remain confidential and stored securely. There are rare circumstances where confidentiality may need to be broken, such as where there is a serious concern about your safety or the safety of another person, or where required by law. This would normally be discussed with you whenever possible.
Signature* Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.
Once I receive your completed form, I will read it carefully and contact you to arrange an initial meeting. Our first meeting is an opportunity for us to get to know one another, explore what has brought you to therapy, and consider together whether Vocal Psychotherapy feels like the right approach for you.
