All Services Intake form

Couples, Family and Marriage Counselling Intake Form

Thank you for choosing Transform Happily! We're offering a free complimentary session to support you on your journey. Please take a moment to answer a few quick questions so we can personalize your experience.

1. What are your main reasons for seeking counselling? (Select all that apply)

Communication Issues
Trust & Infidelity Concerns
Conflict Resolution
Intimacy & Emotional Connection
Pre-Marital Counselling
Separation or Divorce Support
Other (please specify)

2. Are you seeking counselling alone or with your partner?
Alone With my partner

3. Have you ever received Couple or Family counselling before?
Yes No

4. When would you like counselling to start?
As soon as possible Within the next week Within the month In the next few months As recommended by the counselor

5. What days work best for you? (Select all that apply)

Weekdays Weekends

6. What time(s) are you available? (Select all that apply)

Mornings Afternoons Evenings

7. How many sessions would you like to have?
Single session 3-5 sessions Ongoing support I would like to discuss this with the counselor

8. Anything else you'd like us to know? (Optional)

Start your journey to a healthier relationship with a free session!

Talk Therapy Intake Form

Thank you for choosing Transform Happily! We're offering a free complimentary session to support you on your journey. Please take a moment to answer a few quick questions so we can personalize your experience.

1. What brings you to therapy? (Select all that apply)

Anxiety & Stress Management
Depression & Low Mood
Relationship Issues
Trauma & PTSD
Self-Esteem & Confidence
Grief & Loss
Other (please specify)

2. Is this service for you or someone else?
For myself For someone else

3. Have you ever received therapy or counselling before?
Yes No

4. What is the age of the person seeking therapy?
Under 18 18-30 31-50 50+

5. What days work best for you? (Select all that apply)

Weekdays Weekends

6. What time(s) are you available? (Select all that apply)

Mornings Afternoons Evenings

7. When would you like counselling to start?
As soon as possible Within the month In the next few months I would like to discuss this with the professional

8. How ready are you to begin therapy?
I'm ready to book a session I'm exploring my options Just gathering information

9. Any additional details you'd like us to know? (Optional)

Career Counselling & Coaching Intake Form

Thank you for choosing Transform Happily! We're offering a free complimentary session to support you on your journey. Please take a moment to answer a few quick questions so we can personalize your experience.

1. What are your main career concerns? (Select all that apply)

Career Change and Transition
Job Search and Interview Preparation
Workplace Stress and Burnout
Confidence and Leadership Development
Career Growth and Advancement
Work-Life Balance
Other (please specify)

2. Is this service for you or someone else?
For myself For someone else

3. Have you ever received career counselling or coaching before?
Yes No

4. When would you like to start career counselling/coaching?
As soon as possible Within the month In the next few months I would like to discuss this with the professional

5. What days work best for you? (Select all that apply)

Weekdays Weekends

6. What time(s) are you available? (Select all that apply)

Mornings Afternoons Evenings

7. How frequently would you like coaching sessions?
One-time session Weekly Bi-weekly Monthly

8. How ready are you to start career coaching?
Ready to book a session Exploring my options Just gathering information

9. Do you have any additional details you'd like to share? (Optional)

Your dream career is within reach. Submit your responses, and we'll get in touch soon!

Mindfulness and Meditation Intake Form

Thank you for choosing Transform Happily! We're offering a free consultation to support you on your journey. Please take a moment to answer a few quick questions so we can personalize your experience.

1. What are your main goals for mindfulness and meditation? (Select all that apply)

Stress and Anxiety Reduction
Improved Focus and Clarity
Emotional Balance and Well-being
Better Sleep and Relaxation
Spiritual Growth and Self-Discovery
Other (please specify)

2. Is this service for you or someone else?
For myself For someone else

3. Have you practiced mindfulness or meditation before?
No, I am a beginner Yes, I have experience

4. When would you like to start your mindfulness/meditation practice?
As soon as possible Within the month In the next few months I would like to discuss this with the professional

5. What days work best for you? (Select all that apply)

Weekdays Weekends

6. What time(s) are you available? (Select all that apply)

Mornings Afternoons Evenings

7. How ready are you to begin your mindfulness journey?
Ready to book a session Exploring my options Just gathering information

8. Do you have any additional details you'd like to share? (Optional)

Counselling Intake Form

Thank you for choosing Transform Happily! We're offering a free complimentary session to support you on your journey. Please take a moment to answer a few quick questions so we can personalize your experience.

1. What are your counselling needs? (Select all that apply)

Anxiety & Stress Management
Depression & Emotional Well-being
Relationship & Family Issues
Trauma & PTSD
Self-Esteem & Confidence
Grief & Loss
Addiction
Other (please specify)

2. Is this service for you or someone else?
For Myself For someone else

3. Have you ever had a counselling before?
Yes No

4. How old is the person seeking counselling?
Under 18 18-30 31-50 50+

5. When would you like counselling to start?
As soon as possible Within the next month In the next few months I would like to discuss this with the professional

6. What days work best for you? (Select all that apply)

Weekdays Weekends

7. What time(s) are you available for counselling? (Select all that apply)

Mornings Afternoons Evenings

8. How ready are you to start counselling?
Ready to book a session Exploring my options Just gathering information

9. Do you have any additional details you'd like to share? (Optional)

Your path to healing starts with a free session. Submit your responses, and we'll get in touch soon!

Full Name

Age

Gender

Email

Contact Number

City

Intake Forms

Couples, Family and Marriage Counselling Intake Form

1. What are your main reasons for seeking counselling? (Select all that apply)

2. Are you seeking counselling alone or with your partner?

3. Have you ever received Couple or Family counselling before?

4. When would you like counselling to start?

5. What days work best for you? (Select all that apply)

6. What time(s) are you available? (Select all that apply)

7. How many sessions would you like to have?

8. Anything else you’d like us to know? (Optional)

Talk Therapy Intake Form

1. What brings you to therapy? (Select all that apply)

2. Is this service for you or someone else ?

3. Have you ever received therapy or counselling before?

4. What is the age of the person seeking therapy?

5. What days work best for you? (Select all that apply)

6. What time(s) are you available? (Select all that apply)

7. When would you like counselling to start ?

8. How ready are you to begin therapy?

9. Any additional details you’d like us to know? (Optional)

Career Counselling & Coaching Intake Form

1. What are your main career concerns? (Select all that apply)

2. Is this service for you or someone else?

3. Have you ever received career counselling or coaching before?

4. When would you like to start career counselling/coaching?

5. What days work best for you? (Select all that apply)

6. What time(s) are you available? (Select all that apply)

7. How frequently would you like coaching sessions?

8. How ready are you to start career coaching?

9. Do you have any additional details you'd like to share? (Optional)

Mindfulness & Meditation Intake Form

1. What are your main goals for mindfulness and meditation? (Select all that apply)

2. Is this service for you or someone else?

3. Have you practiced mindfulness or meditation before?

4. When would you like to start your mindfulness/meditation practice?

5. What days work best for you? (Select all that apply)

6. What time(s) are you available? (Select all that apply)

7. How ready are you to begin your mindfulness journey?

8. Do you have any additional details you'd like to share? (Optional)

1. What are your counselling needs? (Select all that apply)

2. Is this service for you or someone else?

3. Have you ever had a counselling before ?

4. How old is the person seeking counselling?

5. When would you like counselling to start?

6. Which day(s) are you available for counselling? (Select all that apply)

7. What time(s) are you available for counselling? (Select all that apply)

8. How ready are you to start counselling?

9. Do you have any additional details you'd like to share? (Optional)

Intake Forms

Couples, Family and Marriage Counselling Intake Form

Talk Therapy Intake Form

Career Counselling & Coaching Intake Form

Mindfulness and Meditation Intake Form

Counselling Intake Form

Thank you for your submission!

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