Gestalt Therapy International

A community of dialogue

Programs around the world

Facilitating authentic living & working

Client Intake Form

New clients must fill out this form. If you are a couple, enter information for each person as a separate submission.

If client is a child, parent fills in all your details, and put child's name in the relevant box.

All information is strictly confidential. We do not, under any circumstances, give your information out to any 3rd party.

Select fee



Check to indicate agreement to having read and understood the disclosure statement

Yes, I have read, understand and agree to the Informed consent statement, including the cancellation policy