Getting Started

All information provided here will remain confidential.

This intake form asks for basic personal information. Before filling it out, please ensure you have read and agreed to the Terms of Practice & Informed Consent.

If you have questions before getting started, please visit the FAQ section or reach out at holly@hollymak.com.

After you submit this form, Holly will get in touch with you directly.

Have you read and agreed to the Terms of Practice and Informed Consent?

Yes

What is your name?

First Name

Last Name

What is your email?

Where are you based?

(required)

What are your preferred pronouns?

What is your age?

Which counselling format(s) would you prefer?

What main issues are you seeking counselling about?

How did you hear about Holly Mak Counselling?