Client Intake Form

Terms of Service

As part of providing a counselling service to you, Peter Grimes Online Counselling will need to collect and record personal information from you that is relevant to your current situation. This information will be a necessary part of the assessment and intervention that is conducted.You may access the material recorded in your file upon request, subject to the exception in National Privacy Act 1988.


All personal information gathered by the counsellor during the provision of the counselling service will remain confidential and secure except when:

1. It is subpoenaed by a court, or

2. Failure to disclose the information would place you and/or another person at risk; or

3. Your prior approval has been obtained to

  • Provide a written report to another professional or agency e.g. a GP or a lawyer; or 

  • Discuss the material with another person e.g. a parent or employer.

Electronic Information

It is not possible to guarantee the protection of information that is transferred or stored electronically. Therefore, the Client waives any action legal or otherwise against Peter Grimes Online Counselling and holds Peter Grimes Online Counselling harmless for any interception of Client information resulting from the use of electronic information.

Fees and Payments

Session fees are charged as per the rates listed on our website. Payment is made prior to appointment electronically through PayPal as a subscriber or using a credit or debit card. Failure to show for an appointment, or give at least 24 hours’ notice of cancelling, may incur a fee of 50% of the session fee. Appointment length is 1 hour.

Click here to view our privacy policy