AES-256 Encrypted Clinical Transmission

Confidential Client Intake

Please complete this confidential questionnaire prior to your initial consultation. All clinical responses are encrypted with AES-256-CBC cryptography before database insertion and stored in accordance with Australian Privacy Principles (APPs) and APS guidelines.

Client Identification & Contact

Full Legal / Preferred Name *

Date of Birth *

Email Address *

Phone Number *

Emergency Contact (Name & Phone) *

Referring GP & Medical Clinic

Preliminary Mental Health & Neurodivergence

Responses in this section are encrypted with AES-256 before disk storage

Primary Concerns & Goals for Psychological Consultation *

Neurodivergent Profile & Traits (ADHD, Autism, AuDHD, Dyspraxia, etc.)

Mental Health History & Previous Psychological Care

Current Medications & Dosages

Sensory Sensitivities / Accommodations Needed

Safety & Risk Screening *

Note: This is an outpatient practice and does not offer acute emergency crisis services. For urgent support, call Lifeline on 13 11 14 or 000.

I confirm that the above clinical information is accurate to the best of my knowledge. I consent to my encrypted information being stored securely within Sky Maree Steele's practice management database in accordance with Australian clinical guidelines and the Privacy Act 1988.

Protected by 256-bit CBC military-grade encryption

Confidential Clinical Intake Form

Confidential Client Intake

Client Identification & Contact

Preliminary Mental Health & Neurodivergence