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Individual Counselling: *
Group Counselling (OPTIONAL):
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Preferred Call time at night: *
I have decided to work with the Midnight Listeners because of: *
These are my expectations from the sessions: *
I AGREE THAT EVERYTHING WE DISCUSS WILL BE CONFIDENTIAL, EXCEPT IF IT WOULD HARM ME OR SOMEONE ELSE AND I AM RESPONSIBLE FOR MY COMMITMENT TO ACHIEVING MY OUTCOMES.
I CERTIFY THAT I AM EMOTIONALLY PREPARED, PHYSICALLY SOUND AND FINANCIALLY READY TO UNDERGO MY SESSIONS
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