Personal Details *

First Name

Last Name

Is this your legal name or your non-legal name that you go by? *

Legal name

Non-legal name that I go by

Phone *

(###)

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Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact *

First Name

Last Name

Emergency Contact Phone *

(###)

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Are you an NDIS Participant? *

I am not currently a registered NDIS provider but if you are an NDIS participant whose funding is self-managed or plan managed, your art therapy sessions can potentially be covered by your NDIS funding. If your plan is NDIA managed, your funding will not cover our art therapy sessions.

Yes, I am an NDIS participant

No, I am not an NSID participant

Optional Tools *

These are some tools I often find useful in a session. Please select any that you're open to us using in a session together.

Tarot or oracle cards

Meditation

Movement exercise to help us connect with our bodies

Going for a neighbourhood walk

A hug

My hand on your shoulder

Tasks & Nervousness *

Do any of the following make you feel nervous or uneasy?

Art making of all kinds

Drawing/painting

Exercises that focus on the body

Movement Exercises

Reading and/or writing

Understanding/following instructions

Attending a therapy session

Physical touch

None of the above

Masks in Sessions *

I generally conduct sessions without a mask. Please specify your mask preference.

Masks on please

Without masks is fine

Health and Infection Control *

As a practitioner with lived experience of chronic illness, I take extra caution and care with my health and the health of others. If you have any symptoms that indicate a possible cold or virus, regardless of a negative RAT, we will either reschedule your sessions or do our session over zoom. I ask for your honesty and vigilance in assessing risks and that you keep in mind that a common cold can see me in bed for several weeks. Please consider contact you've had with people who are sick, be generous with recovery time before attending a session and keep me in the loop regarding your health circumstances. In return, you can feel confident knowing that I will not conduct a session if I'm experiencing symptoms that might put you at risk or if I'm knowingly in close contact with someone who has a cold or a virus.

I agree to avoid face to face sessions if experiencing symptoms. I agree to exercise vigilance in assessing health risks and will contact Sass via phone or email prior to a session to discuss and possible concerns.