Counselling with Scott

Intake Form

Thank you for your interest in speaking with Scott. Please fill out this form as honestly as possible. All information is completely confidential and will not be shared.

Name

Age

Country

Who referred you or how did you find me?

Tell me more about your situation and what you would like to achieve as a result of our call

Is there a spiritual or faith-based part of your life that’s important to you?

What do you love to talk about and/or love doing?

Are you currently employed full-time?

Yes

Is there anything else you'd like me to know before we meet?

Counselling with Scott

Intake Form

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