Family intake form

Assalamu alaikum, and thank you for booking your Family Wellness Consultation Package. Please complete this at least 48 hours before your first session, so our time is spent on guidance, not questions.

There are no right or wrong answers. Share as much or as little as feels comfortable, and skip anything you would rather talk through in person. Everything you share is kept confidential.

Your package

  1. Initial consultation60 minutes

    Understanding your child and family, your goals, and a personalised starting plan

  2. Follow-up session 130 minutes

    Reviewing progress, adjusting the plan, answering questions

  3. Follow-up session 230 minutes

    Final review, long-term routine and next steps

Suggested spacing: follow-ups around 2 to 3 weeks apart, so there is time to try changes gently.

About you and your child

Parent or guardian

Preferred contact method

Your child

School setting
Do they have an EHCP or SEN support?
Will your child join any of the sessions?

Your answers are saved on this device as you go.