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Sign In
My Account
HOME
ABOUT
SERVICES
MEDIA
FAQ
TESTIMONIALS
CONTACT
Somatic Sexologist
COUPLES INTAKE FORM
KIA ORA, I'M LOOKING FORWARD TO WORKING WITH YOU.
I'D LOVE YOU TO ANSWER A FEW QUESTIONS BEFORE OUR SESSION:
Name
*
First Name
Last Name
Email
*
Name of Partner
Relationship Status
Married
Dating
Living Together
Living apart
Length of time in current relationship
What do you most want to get from our time together? This can be answered differently from each partner if appropriate:
Are you or your partner currently suffering from any physical or emotional symptoms related to a traumatic experience? Y / N (If yes, please explain)
Is this your first couples therapy session? Y / N (If no please provide some details)
Is there anything else you would like me to know?
By signing this form you agree to all the below
This is not psychotherapy or medical treatment I understand that any touch will be given only at my request and solely for my own benefit, education and support. I have stated all medical conditions that I am aware of, and I will update Morgan on any changes in my health status.
Yes I understand
CANCELLATION AND RESCHEDULING AGREEMENT
CANCELLATION POLICY - If you need to cancel your appointment this has to be done 3 days prior to session time for you to receive a refund. Cancellations or Rescheduling within the 24 hours prior to appointment time will incur a fee of $50 IN THE CASE OF YOUR PRACTITIONER RESCHEDULING YOUR SESSION - If for some reason your practitioner needs to reschedule your session a new time will be arranged and your payment will be carried over. In the case that your practitioner needs to reschedule and you are unable to find a new time that suits you both, your practitioner will refund your payment. Thank you for understanding and respecting my work by honouring this agreement. Do you agree to the cancellation and rescheduling agreement?
Yes I understand
Thank you, Morgan will be in touch to confirm booking.