INTAKE + CONSENT FORM Paʻa Sessions | Institute of Living Aloha

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Chosen name/s (if different from above)

Pronouns

Email

Address

Phone

Birthday

Day

Month

Year

Emergency contact name + phone number

Please indicate your main reason for booking a Pa'a Session

General Pa'a Support

Pre-Practitioner Assessment

Mentoring

Supervision

Have you engaged in any type of counselling/supervision/mentoring before?

Yes

No

Please note: For Supervision or Pre-Practitioner Assessment bookings, reflection questions will be emailed to you to support your preparation for the Paʻa Session.

Completing the following questions is optional, and only if you feel they would be supportive or helpful.

Was your experience of this mostly positive or negative? What worked well for you/didnʻt work for you?

If you haven't already shared this, or if it's changed, please share anything that you would like to work on/get out of you Pa'a Session/s

Have you experienced any recent trauma and/or big life changes that you would like to share before your session?

Do you have any diagnoses that would be helpful to share before your session?

Is there anything else that you would like to share before your session?

Please read our Cancellation + Privacy Policies

I agree to the Cancellation Policy for Paʻa Sessions

Yes

I agree to the Privacy Policy for Paʻa Sessions

Yes

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Mahalo (thank you) for booking a Paʻa Session Please fill in this form prior to your first session...

Mahalo (thank you) for booking a Paʻa Session

Please fill in this form prior to your first session...