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Self Declaration
Rose Cottage Holistic Therapy
Self Declaration before attending
Click to enter text
Have you had any symptoms influenza in the past 24 hours?
Are you taking any prescribed medication at present.
Is there any mental health issues with you or in your family I need to be aware of before attending counselling?
Are you at risk to yourself or someone else right now?
Do you agree to adhere to the ethics and code of conduct of your counsellor and by signing an agreement you are willing to engage fully?
Are you in active addiction now?
Click by ticking here I agree that I have answered the above honestly and I am attending Counselling at my own request for the greater good. here to change