By signing this form, I agree I have received an Assessment Session with a qualified Therapist undertaken by DisabilityPlus Counselling & Psychotherapy.
The Therapy Session was taken with the sole purpose of gathering information from me to enable DisabilityPlus to submit a Funding Request Document on my behalf.
I understand that the information within the document will be shared with my doctor & subsequently shared with a funding panel to determine my suitability for specialist counselling.