Client details form

Please provide the details below before your first session. This will help us prepare and ensure that the entire session time is dedicated to you and your current concerns (not to completing forms!)

Full name *

Date of birth *

Address *

Phone number *

Email *

Preferred method of communication:

Email
Phone/Text

Gender

GP (Name/Practice) *

Emergency contact (Name/phone number) *

Kessler score (see instructions below)

Kessler Psychological Distress Scale (K10)

Please complete the online questionnaire ( https://www.healthnavigator.org.nz/tools/d/distress-scale-kessler-10/) and record your final score above.

Have questions?

fabricia@nestcounselling.co.nz