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Marriage Counseling Intake Form
I need a Marriage Counseling Intake Form for my private practice in Leeds that complies with UK GDPR and includes specific sections for domestic violence screening and cultural sensitivity, as I work primarily with multicultural couples.
1. Personal Information: Basic contact details, emergency contacts, and demographic information required under Data Protection Act 2018 and UK GDPR compliance
2. Relationship Status: Current relationship status, length of marriage/relationship, previous marriages, and relevant relationship history
3. Presenting Issues: Primary concerns bringing the couple to counseling and desired outcomes from therapy
4. Medical History: Relevant physical and mental health information, including current medications and treatments
5. Consent for Treatment: Informed consent and acknowledgment of counseling terms, including BACP/UKCP ethical guidelines
6. Confidentiality Statement: Privacy policy and limits of confidentiality as per UK GDPR and professional standards
1. Children Information: Details about children including ages, living arrangements, and relevant safeguarding considerations under Children Act 1989
2. Previous Counseling Experience: History of prior therapy or counseling, including outcomes and approaches used
3. Cultural/Religious Considerations: Specific cultural or religious factors affecting counseling, addressing Equality Act 2010 requirements
4. Domestic Violence Screening: Assessment of safety concerns and risk factors, including safeguarding protocols
1. Fee Schedule: Detailed breakdown of counseling fees and payment policies in compliance with Consumer Rights Act 2015
2. Privacy Notice: Detailed GDPR-compliant privacy information and data protection procedures
3. Counseling Agreement: Terms and conditions of counseling service, including rights and responsibilities
4. Crisis Resources: List of emergency contacts, support services, and crisis intervention procedures
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