Free Therapy Booking Form Template
Therapy Booking Form
Please fill out the form below to schedule your therapy session.
Name
Phone number
Appointment Date
Appointment Time
Therapy Type
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Cognitive Behavioral Therapy (CBT)
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Psychodynamic Therapy
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Family Therapy
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Couples Therapy
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Trauma Therapy
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Grief Therapy
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Art Therapy
Session Format
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In-Person
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Virtual Meeting
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Phone Consultation
Select Duration
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30 Minutes
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45 Minutes
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60 Minutes
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90 Minutes
Are you taking any medications?
Do you have any diagnosed mental health conditions?
Do you have any physical conditions or disabilities that we should be aware of?
Emergency Contact Information
Name
Phone number
Relationship
Cancellation Policy
Please note that cancellations or rescheduling must be made at least 24 hours in advance. Failure to cancel within this time frame may result in a cancellation fee.
Client Consent
By signing below, I acknowledge that all information provided is accurate and I consent to participating in therapy sessions based on the details provided.
Name:
Date:
Booking Form Templates @ Template.net
Thank you for booking with us!
We look forward to serving you.
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