Adult Client Intake Form

    Client information

    Next of Kin

    In case of emergency

    General health and mental health information

    Family Mental Healthy History

    In this section below identify if you or any of your family member identify with any of the following. 

    Additional Health and Mental Health Information

    FDV Questions

    Additional Information

    Informed Consent and Disclosure Statement for Counselling Services

    Privacy Policy

    Azelene Williams Privacy Policy

    1. Introduction

    Azelene Williams is committed to protecting your privacy. This Privacy Policy explains how we collect, use, disclose, and safeguard your information when you visit our website azelenewilliams.com, or engage with our services. By using our website and services, you agree to the collection and use of information in accordance with this policy.

    2. Information We Collect

    We collect various types of information, including:

    Personal Information: Name, email address, phone number, and other contact details.

    Sensitive Information: Information related to your mental health, treatment history, and other sensitive data relevant to our counselling services as part of our intake process.

    Usage Data: Information on how you interact with our website, such as IP address, browser type, and pages visited.

    3. How We Use Your Information

    We use your information to:

    • Provide and manage our counselling services.

    • Communicate with you, including responding to inquiries and providing updates.

    • Improve our services and website.

    Comply with legal obligations and the Australian Association of Social Workers (AASW) and Australian Counselling Association (ACA) guidelines.

    4. Disclosure of Your Information

    We do not share your personal or sensitive information with third parties except:

    • With your consent.

    • To comply with legal requirements or respond to lawful requests by public authorities.

    • To protect and defend our rights and property.

    5. Data Security

    We take reasonable steps to protect your information from unauthorized access, use, or disclosure. However, no method of transmission over the Internet or electronic storage is 100% secure.

    6. Your Rights

    You have the right to access, update, or delete your personal information. You may also object to the processing of your data or request restrictions. To exercise these rights, please contact us at azelenewilliams@gmail.com

    7. Changes to This Policy

    We may update this Privacy Policy from time to time. We will notify you of any changes by posting the new policy on our website. Your continued use of our services after any changes constitutes your acceptance of the new Privacy Policy.

    8. Contact Us

    If you have any questions about this Privacy Policy, please contact us at:

    Email: azelenewilliams@gmail.com
    Phone: +61 405 246 176

    Terms of Service

    Azelene Williams Terms of Service

    1. Introduction

    These Terms of Service ("Terms") govern your use of the Azelene Williams website and services. By accessing our website and services, you agree to comply with these Terms.

    2. Services

    Azelene Williams offers counselling, coaching and public speaking services. These services are provided in accordance with the guidelines set forth by the Australian Association of Social Workers (AASW) and the Australian Counselling Association (ACA).

    3. Client Responsibilities

    Clients are expected to:

    • Provide accurate and complete information during the counselling process.

    • Attend scheduled sessions on time and notify us of cancellations at least 24 hours in advance.

    • Engage in the counselling process with an open and honest approach.

    4. Confidentiality

    All client information is kept confidential, except in situations where disclosure is required by law or necessary to prevent harm to the client or others. For more details, please refer to our Privacy Policy.

    5. Payment and Fees

    Fees for services are outlined on our website or discussed during the initial consultation. Payments are due at the time of service unless otherwise arranged. We accept direct transfers, direct deposits, and PayPal.

    6. Cancellation and Refund Policy

    Clients must notify us of cancellations at least 24 hours before the scheduled session. Failure to do so may result in a 50% cancellation fee. Refunds are handled on a case-by-case basis.

    7. Limitation of Liability

    Azelene Williams is not liable for any direct, indirect, incidental, or consequential damages arising from the use of our services. Our liability is limited to the amount paid for the services rendered.

    8. Governing Law

    These Terms are governed by the laws of Western Australia, without regard to its conflict of laws principles.

    9. Changes to These Terms

    We may update these Terms from time to time. We will notify you of any changes by posting the new Terms on our website. Your continued use of our services after any changes constitute your acceptance of the new Terms.

    10. Contact Us

    If you have any questions about these Terms, please get in touch with us at:

    Email: azelenewilliams@gmail.com
    Phone: +61 405 246 176


    Consent and Agreement for Adults.


    Our practice will work closely with other agencies to coordinate the best support for you. This means your informed consent for the sharing of information will be sought and respected in all situations unless:

    • we are obliged by law to disclose your information regardless of consent or otherwise;

    • it is unreasonable or impracticable to gain consent or consent has been refused; and

    • the disclosure is reasonably necessary to prevent or lessen a serious threat to the life, health or safety of a person or group of people.


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