Contact us.Damian@myhealthandmentalwellbeing.com Name * First Name Last Name Parent/ Carer (if client is under 18) Email * Phone (###) ### #### Diagnosis (if any) Services Required Counselling/ Therapy Behaviour Support Unsure Other information * Confidentiality Agreement * Please review the confidentiality agreement linked below. To proceed, please acknowledge that you have read and understood the agreement. I agree Thank you! We will be in touch soon. Confidentiality Agreement