Book a Counseling Session

Full Name

Age verification

I confirm that I am 18 years of age or older.

City

Country

Location Information

I confirm that the location information provided above is accurate.

I agree to notify the counsellor if I attend future sessions from a different province, territory, state, or country.

Nature of Services

I understand that this service provides faith-based Islamic counselling, pastoral counselling, spiritual guidance, marriage counselling, marriage mentoring, and personal development support.

I understand that guidance may be based on Islamic teachings, values, ethics, and principles.

I understand that this service is spiritual, educational, and supportive in nature.

I understand that this service is not psychotherapy, psychiatric care, psychological treatment, or medical treatment.

I understand that no diagnosis of mental health conditions is provided through this service.

I understand that no specific outcomes or results can be guaranteed.

Services may include:

Islamic spiritual guidance
Marriage counselling and mentoring
Premarital counselling
Conflict resolution
Family and relationship guidance
Personal development
Faith and spiritual growth
Goal setting and accountability

Services do not include:

Psychological assessments
Psychiatric services
Mental health diagnosis
Psychotherapy
Medical treatment
Emergency crisis intervention

Confidentiality

I understand that information shared during counselling will be treated as confidential.

I understand that confidentiality may be limited where disclosure is required or permitted by law, including situations involving: * Serious risk of harm to myself * Serious risk of harm to another person * Abuse or neglect where reporting obligations apply * Court orders or legal requirements

Emergency acknowledgment

I understand that this service is not an emergency service.

If I am experiencing an emergency or immediate danger, I understand that I should contact emergency services, a crisis line, or other appropriate local resources.

Referral acknowledgment

I understand that certain situations may require services beyond the scope of faith-based counselling.

Client responsibility

I understand that participation in counselling is voluntary.

I understand that I remain responsible for my own decisions, actions, and choices.

I understand that I may discontinue counselling at any time.

Session Fee

USD (per hour) $75.00

I understand and agree to the current fee structure.

Electronic Consent

I have read and understood this document.

I voluntarily consent to receive faith-based counselling.

By checking this box and submitting this form, I acknowledge that my electronic acknowledgement constitutes my consent and agreement to the terms above.

Book A Counseling Session

Book A Counseling Session

Counseling Intake Form