In requesting professional consultation and assistance, I understand that to be successful I must be entirely willing to:
Recognise that my health and well being depend directly on how well I care for myself emotionally, physically, spiritually and intellectually.
Accept responsibility for myself, my choices and actions and that I, knowingly or unknowingly, create them.
Agree to participate wholeheartedly in the therapy sessions. I know my heartfelt commitment is an important first step in my work here and my signature below underscores that commitment.
If, in all good conscious however I cannot align myself fully with each statement above, I have initialled each acceptable item rather than signing at this time and agree to discuss in detail any reservations I may have.