IBT – Intake Form

Integrated Body Therapy is a confidential process designed to help you address your concerns, come to a greater understanding of yourself in your emotional and physical form.  It involves a relationship between you and a trained therapist who has the desire and willingness to help you accomplish your individual goals. Integrated Body Therapy involves sharing sensitive, personal, and private information that may at times be distressing. During the course of therapy, there may be periods of increased anxiety or confusion. The outcome of therapeutic work is often positive; however, the level of satisfaction for any individual is not predictable. Your therapist is available to support you throughout the process.


All interactions with Integrated Body Therapy including scheduling of or attendance at appointments, content of your sessions, and your records are confidential.


•     Your therapist may consult with her external supervisor to ensure the provision of best possible care. These consultations are for professional and ongoing training purposes.

•     If there is evidence of clear and imminent danger of harm to self and/or others, a therapist is legally required to report this information to the authorities responsible for ensuring safety.

•     Notes from sessions may be subpoenaed, should this occur we will be in consult with you around this.

We appreciate prompt arrival for appointments. Please notify us at 0498112936 if you will be late. Twenty-four hour notice of cancellation allows us to use the time for others.

The fees for the treatment sessions have been outlined and are inclusive of GST.

Payment for services is required at time of session.

By completing the following intake form and I acknowledge I have read and discussed the above information with my therapist. I understand the risks and benefits of Integrated Body Therapy, the nature and limits of confidentiality, and what is expected of me as a client.