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. 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

    Briefly describe reason for reaching out to us

    Do you want to register an emergency contact

    By ticking the box below I agree that cancellation 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 will are liable all unpaid fees.