Intake Form

This page works best on Google Chrome.

By submitting this form, you agree to all policies by Psychology Blossom.

This agreement governs any psychological services provided to you or other persons that you are nominating to interact with Psychology Blossom.

We consider that the data we collect and record from you is true and accurate. Your personal data will be stored in accordance with the Personal Data Protection Act (PDPA). You can request to update this data at any point in the future. In the event that you choose to conceal certain information, please be mindful that this may have adverse effects on your therapy progress. Please read the privacy policy here: <link>

Psychology Blossom values confidentiality. Your personal information will remain confidential and will be confidentially stored with professional staff at Psychology Blossom.
Protecting your personal information is a priority for us. We will only disclose to a third party with your permission, or if required by law or a court order. In addition, confidentiality may be broken in the event of perceived risk of serious or immediate harm to the client or others, information regarding the risk or abuse of minors, In such situations, we are duty bound and compelled by law to inform the appropriate authorities and relevant persons, such as your emergency contact, who can best provide the support to prevent such injury or harm. Your emergency contact may also be contacted In the event of a medical emergency, or to collect unpaid fees to Psychology Blossom Pte. Ltd. Essential therapy practice includes supervision, where therapists develop professionally under close guidance of their clinical supervisor. This is standard clinical practice and confidentiality is protected during these consultations. All materials remain the property of Psychology Blossom.

You agree that Psychology Blossom is not responsible for any loss you suffer, of any nature, from the use of Psychology Blossom’s website or our psychological services. We exclude from any loss liability to the fullest extent permitted by law. We expressly disclaim any liability for any omission, inaccuracy, error, or misstatement in the content or materials that are provided to you or posted on our website www.psychologyblossom.com.

We accept cash, PayNow, PlatoPay, or credit card payments. We accept VISA and Mastercard, with an administration fee of 2.5%.

When making a booking, Clients are required to complete the intake form, and provide accurate personal information together with a credit/debit card encrypted on file. Psychology Blossom will not charge the card without prior notification, unless it is an outstanding for more than 24 hours.

Online appointments will not be confirmed until a card is encrypted on the client's file. Failure to encrypt your card to your file prior to the appointment may result in the cancellation or rescheduling of the session, at the discretion of Psychology Blossom.

Please book a longer session if you are unsure on the exact time you require for your therapy, as your therapist may not have additional time for an extension.

Matters such as rescheduling therapy, checking homework, and discussing administrative matters are considered as part of the therapy session. While sessions are typically scheduled for 50 or 80 minutes, please allocate 5-10 minutes of this time for wrapping up and making another appointment, if needed. Please bring up any important matters at the start of your therapy session as your therapist is unlikely to have the necessary time to address any important matters brought up towards the end of your session.

Please consult with your therapist or administrative staff for the different rates that may apply for atypical services, such as outcalls and writing reports. Such fees are calculated as a function of time and day, venue (e.g. outcalls), and the nature of the services that are provided.

You will be discharged from therapy if you do not have any sessions with us after 3 calendar months. Psychology Blossom reserves the right to increase the fees each calendar year. New rates, if any, may not be formally informed and shall be applied to all clients. Please kindly check the website for any updated fees or enquire directly with us if you have not seen your therapist for more than 3 calendar months.

Please be punctual for your appointments as your sessions continue to conclude at the scheduled time in the event that you arrive late. This is due to back-to-back bookings that are the norm in psychotherapy.

For rescheduling or cancellations of appointments, please note that we require a minimum 48-hour notice* prior to the scheduled appointment time. Our policy is that cancellations made in less than our notice period incur 100% of the session fee (unless a special arrangement has been made with your therapist).
*The 48-hour notice period is essential in a psychology practice in order for your therapist to best prepare for your session and personalise it to suit your needs. Given that the time slot, therapist, and consultation room can be allocated to another client in dire need, our terms and conditions encourage all clients to consider these factors and submit this form in agreement to commit to the scheduled sessions.

Payment for online sessions or home visits must be made in full prior to the scheduled appointment. Otherwise, exceptions can be made based on mutual agreement in writing between the client and Psychology Blossom. Failure to provide payment prior to the appointment may result in the cancellation or rescheduling of the session at the discretion of Psychology Blossom.
If the client is claiming insurance, it is the Client's responsibility to check the level of coverage and confirm with their insurer or sponsor that their therapy at Psychology Blossom is covered by their policy. Psychology Blossom does not do any insurance direct billing, or provide administration support for your insurance. In addition, we do not accept requests from Clients for adjustments to the invoice itemised and provided to you due to accounting audit purposes.

All fields are required to be completed in full.

Gentle Start-Up in Couples Communication