Initial Questionnaire

Preparing for your Initial Appointment

Whether you are coming to our premises for your initial appointment, or attending it remotely, there are some important preparations you should make.  These ensure that you and your assessment counsellor can carry out and complete the session effectively.

Please make sure you have read our Client Information Sheet, and any Guidelines you have been sent. Let us know if you feel there is anything that you cannot manage about working remotely or accessing our premises. Our guidelines for remote sessions were attached to the email you received, but can also be downloaded here: Remote Session Guidelines

For Video Sessions, it is important that you check your device and software works with Attend Anywhere before the start time of the appointment. Go to and follow the instructions until you receive the message welcoming you to the PF ‘waiting area’.

    Initial Client Questionnaire

    Please complete and submit this questionnaire by the deadline given in our email. Providing as much detail as possible here will allow us to make best use of the time available at your appointment. All information will be kept strictly confidential.


    Your PF Client Reference (given in the email you received from us) (required):
    Your home address:
    Your email address (required):
    Your Date of Birth:     
    Your Age:
    Ethnic Origin: 
    How did you hear about the PF? 
    GP Surgery where you are registered: 
    Name of your GP, if appropriate:
    If your GP recommend the PF to you, would you like us to notify your GP when you begin and end counselling?   NoYes
    Employment status: 
    Background history
    Please tell us about any significant health problem or disabilities you would like us to know about:
    What medicines (and doses, if known) are you currently taking, for what conditions? 
    How would you describe your use of alcohol or recreational drugs, now and in the past?  
    Have you ever physically harmed yourself in any way, and how do you feel about this now? 
    Have you ever considered taking your own life, and how do you feel about this now?  
    If you have had counselling in the past, please tell us a bit about that (when, approximately how many sessions, themes):
    Do you have any particular requirements or preferences regarding your counselling at PF?  
    Social Situation
    Please outline your occupation, living arrangements, close relationships, emotional support: 
    What Days and Times would you be available on a regular basis?  Please tell us your availability for for face-to-face sessions, and how it might be different for remote sessions.
    Working Remotely
    We'd like to know a bit about how prepared you are to have a remote session, given the ongoing uncertainties. Please read the document Video and Phone Counselling and briefly confirm:

    Your level of experience and familiarity with technology devices, internet, etc:
    How you will ensure the right sort of space for yourself on a regular basis:
    Which communications method you will be using. (Please choose below):

    Send Us Your Form

    Please click here to verify:

    Click the 'Send' button to submit your form: