New Client Intake Form & Agreement

This form is to provide an overview of the service of Danielle Hanrahan Coaching. As part of providing this service, we will need to ask for personal contact information. This will be kept confidential, and is used only for the purposes of conducting our service. Once the service is concluded, this private information will be destroyed.

This form must be completed by all new clients prior to your first consultation/session. If you have any questions while completing this form, please contact - hello@daniellehanrahan.com. Scroll down to complete the form and please remember to hit the ‘Submit’ button. By submitting, you agree to the Privacy Policy, Terms & Conditions, and Confidentiality Agreement (see below). Thank you!!

Name

First Name

Last Name

Phone

(###)

###

####

Occupation

Have you had a session with a psychologist, counsellor or coach before?

How did you hear about my coaching practice?

What are you hoping to gain from our time together?

Do you have any other questions or comments prior to commencing our session?

Confidentiality

All personal information gathered by the practitioner during the provision of the counselling and coaching service will remain confidential and secure except where: 1. It is subpoenaed by a court. 2. Failure to disclose the information would place you or another person at serious and imminent risk. Other limits to confidentiality include clinical supervision. It is my responsibility to regularly upgrade my professional knowledge and seek regular consultation with an approved supervisor, such as a registered psychologist, registered social worker, or registered clinical counsellor. The identity of the client is protected while client situations are discussed. Please note that, despite being set up to offer a high level of security, communication over the internet cannot be guaranteed to be completely secure. Our chosen platform, Zoom, does not store any content from the sessions themselves, however, the fact that a session took place (including IP addresses, session names, email addresses) are stored by Zoom. All notes, copies of letters and reports executed on behalf of you, the client, during the therapeutic process are the sole property of the coach. By submitting this form, I have read that I understand the above Consent Form and agree to these conditions for the coaching services provided by Danielle Hanrahan, Therapy and Coaching. Please note: If you have any questions or concerns about this Consent Form, or if you are at all unsure about what is written on this page, please discuss it with Danielle Hanrahan.

I understand.