Free online counselling service in South Africa
Humanitas Counselling Request
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Counselling request and consent form
First Name
Last Name
Email
OTP has been sent to the email address provided.
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Please enter the OTP below.
Contact Number
ID Number
Reason for Counselling
Age Declaration
Select an option
I am older than 18 years of age
I am younger than 18 years
Emergency Contact Name
Emergency Contact Number
Humanitas Counselling Intern
Select a counsellor
Gabriella Botha
Jenna-Leigh Du Randt
Kim Machaka
Kian Balton
Please select a Humanitas Counsellor
I understand and agree with the following statements:
I understand and acknowledge; that the person I am about to see is a Counsellor in training, working under the supervision of registered Social Workers in private practice.
I understand that confidentiality will be maintained between my counsellor and I at all times, except for the following reasons:
(1) if it is noted by my counsellor that I am a danger to myself or others.
(2) if there is any suspected child abuse, elder abuse or abuse of people with disabilities.
(3) if it is mandated by the law for legal proceedings.
I understand that if I am younger than 18 my counsellor needs written consent from both parents before being able to see me
Hereby I give consent to be counselled by a counsellor in training; under supervision of Vita Nova Training (Pty) Ltd. T/A Humanitas Training
The terms must be accepted to request counselling.
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