Client Intake Form for Minors

Client Intake Terms and Conditions for Minors

Confidentiality Clause

Dear Parents/Guardians,

Thank you for entrusting me to help your child/ward. This form is to inform you of the nature of the counselling relationship with the client given that the client is a minor.

In ticking the box at the bottom of this form, you consent for me to engage your child/ward in counselling sessions.

The counselling sessions are confidential, and although the client is a minor, I will still seek their express consent before sharing any details about the session(s). This is because I still owe my client the assurance of confidentiality so that they can be reassured of a comfortable and safe counselling relationship.

Having said that, please rest assured that in circumstances where I deem it to be important that I share details of the session(s) with you, I will do so after informing the client. Examples of such circumstances could be:

(a) where there is a genuine concern that the client will harm themselves; and/or
(b) where there is a genuine concern that the client will harm someone else; and/or
(c) where there is a genuine concern of abuse involving the client.

The nature of this confidential relationship as applied specifically to a client who is a minor, will be explained in detail, to the client, i.e. your child/ward.

Please rest assured that the notes of the sessions are maintained only by me and kept in a secure online system. The hand-written notes are duly destroyed once the information has been transferred to the online records system. All your personal data are also stored in a secure online system.

Cancellation Policy

All appointment bookings will be managed by me. Should you need to reschedule the appointment, please do not hesitate to contact me to do so.

If you need to cancel the appointment, please let me know 24 hours before the appointment. Please understand that you will be charged fully for the session if you cancel the session less than 24 hours before the scheduled time or you do not show up for the appointment. This is to account for the time that was set aside for you.

My contact details are as follows:

Mobile: +65 9128 0002

My office address is as follows:

Centennial Tower, Level 21
3, Temasek Avenue
Singapore 039190