+45 4245-4600

Intake Form

Please fill out the form prior to first meeting

Thanks for reaching out to EGOLAB / THERAPIST.dk

To be able to assist you we need some information. As clinical psychologists we are required to know our clients. You can also provide us with an emergency contact at your convenience.

We operate under strict laws protecting your data and confidentiality. As such we will not pass on any health related or personal information to third parties without your specific consent. We do work as a team and your situation may be discussed in a supervisory setting with the purpose of providing the best treatment for you. An exemption is when you are covered by an insurance that we are invoicing directly; where we will supply the necessary information needed for the invoicing such as session dates and name for invoicing. if your life or someone else’s life is in danger due to your behaviours or the welfare of a child is in question, we are required to notify appropriate authorities.

The information below is sent encrypted directly to your counsellor.

 

Online intake form

    You can pay with MobilePay or cash (exact amount). Bank transfers and card payments only when paying in advance.

    Are you interested in online video consultations?

    Briefly describe reason for reaching out:

    Do you want to register an emergency contact and give us consent to this person in case of an emergency?

    By ticking the box below I agree that cancellations and changes later than 9am one working day before the appointment - regardless of reason - is considered a late notice and I will pay for the session. If you are covered by insurance and they - for any reason - stop paying your fees you are liable for unpaid fees.