Online assessment form - Auckland

To give us some idea of your availability please indicate when you would be able to attend appointments (please choose more than one) The counselling service hours are 8.30 am to 4.30 pm Monday to Friday.

If you have already booked an appointment, what day, time and therapist are you seeing?

3. If Yes, have you thought about how you might do this?

4. If Yes, have you had any intention of acting on these thoughts of killing yourself, as opposed to you have the thoughts but you definitely would not act on them?

5. If Yes, have you started to work out or worked out the details of how to kill yourself?

Do you intend to carry out this plan?

1. What has led you to seek Counselling Service at this time?

2. How long have you been experiencing your current difficulties/concerns?

3. What things have you been doing to help you cope either now or in the past (e.g. sleep, attending lectures, drug & alcohol use, eating, exercise, self-harm, gambling, internet, pornography).

4. What would you like from counselling and how would you know if it's working?

5. Is the overuse of alcohol and/or drugs a significant coping strategy for you at present?

6. Where do you get support from? (e.g. family members, friends, a partner, (pet(s), groups/clubs?)

7. Have received professional help for this or any other problem, now or in the past? Who has provided this (select all that apply)

8. Please use this space to provide details of any medical condition or psychological diagnosis you have. (Please list medication you are taking).

9. In this space please include anything else you feel it is important for us to know.

10. Do you have a preference for a particular therapist?  (e.g. male, female, or a specific person, mandarin speaking). This may delay arranging an appointment.