Booking Form

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Child's Name (first & last) and Age - if Applicable *

What would you like to focus on during out time together? *

What is your hope for our time together? *

Confidentiality: All work with Liz McCurdy Therapeutic Art is confidential. There are three situations where confidentiality will be broken. These situations are as follows; if information is shared during a session that indicates someone is hurting you *

Yes, I have read and understand the above information regarding Confidentiality. No, I have further questions and clarification I'd like to discuss.

Scope of Practice: Liz McCurdy Therapeutic Art services do not include counselling. If a situation arose outside our scope of practice, you would be referred to alternate or additional service. *

Yes, I have read and understand the above information regarding Scope of Practice. No, I have further questions and clarification I'd like to discuss.

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Lunenburg, Nova Scotia