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This is the name which will be displayed on screen, in reviews and such. Emails from the site will also be addressed to this name.

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e.g. Oxford, Northumberland

Clinical Details

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If applicable

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Consent

Please tick only those boxes below that you feel comfortable with, before signing the form and returning.

I agree with the conditions of therapy laid out in the information for prospective clients provided by Dilemma Consultancy and hereby give my agreement in principle for my therapist/supervisor to use material from our sessions for publication in the following way:

Only use material from our sessions in an anonymous manner, so that no personal characteristics can be recognised.

Use my own written comments or drawings.

Record some of our sessions and use the transcripts.

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