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About YouName(Required) First Last Preferred nameDOBAddress Street Address Address Line 2 City ZIP / Postal Code Country AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Email Address(Required) Mobile (+country code)(Required)Which session are you booking in for?(Required) Spark Session Untangle Session Descent Sessions Please briefly outline your reason for booking a session with me today(Required)Is this session regarding a creative project? Please give a brief description (all creative rights are confidential – see Privacy and Confidentiality below)(Required)What stage of development are you in this project? (you may be far along in your development process or even just have an idea or want to invoke more creativity in your life, everything goes here!)(Required)Privacy and ConfidentialityI am a registered with the Psychotherapy and Counselling Federation of Australia. As such I am am bound by their strict code of ethics. In the interests of your privacy, all generalised information is only for the use of your psychotherapist. Any notes taken during session are retained using encryption. As an advocate of holistic health, I may advise clients seek addition support from other practitioners. You are not obligated to follow this and should you do so, none of these details will be provided to any external practitioners without your consent. You may withdraw from my practice at any time without penalty or prejudice.ConfidentialityConfidentiality will be broken only under the following scenarios: – If there is imminent threat to your safety If someone you know is being harmed – If there is a subpoena by a court of law – If you disclose information regarding involvement in a criminal offence As a care giver I am committed to meet with you regularly to provide an overview of progress, but this does not include content of sessions. Payments, Cancellations and ChangesPayment will be taken at the time of booking. If you need to reschedule, please give 24 hours’ notice and a full refund will be issued. For clients outside Australia, please double check time differences using this tool: https://www.timeanddate.com/worldclock/meeting.htmlRespect for CountryMy practice resides on lands of the Bundjalung Nation and the Arakwal and Ngangbul people. I respect and honour the traditional custodians for knowledge, wisdom keeping storytelling and healing that went before, exists in the here and now, and in the future.Date MM slash DD slash YYYY