Intake Form

​Would you kindly complete this form and submit it at least ​one day before your first appointment.
If you do not have an appointment yet you can take one scanning the QR code.
​Don't hesitate to contact me if you have any questions: [email protected]

TERMS & CONDITIONS
 
CODE OF ETHICS & PRIVACY
 
The therapist adheres to the provisions of the WBGO and the ethical and other professional codes that apply members of the professional association VIT, vereniging integratieve therapeuten (www.vit.nl).
Privacy of clients is protected conform the AGV European privacy law.
 
SESSIONS
 
The individual sessions have a duration of 60 minutes, relationship therapy session last 90 minutes.
It is possible to have sessions online or in my office near Utrecht, in The Netherlands.
Appointment can be taken via e-mail [email protected]
 
CANCELLATION
 
If you need to cancel an appointment you are requested to do so 24 hours in advance. An agreed session that is not cancelled on time will be charged to the client.
 
PAYMENTS
 
The cost of an individual sessions of 60 minutes and of a couple therapy session of 90 minutes is to be found on the website or requested via e-mail at [email protected]..
The client pays  after the session using a Tikkie that I send (if resident in The Netherlands) or via bank transfer upon receiving an invoice.
 
Lara Briozzo 
It is all about life - Coaching, Counseling & Psychotherapy