Support Person Context and Insight Form Form

This form gives you space to share honest observations about the person you care about who is receiving counselling. Your perspective helps us provide the most effective support possible.

We recognize that sharing difficult observations is not always easy. Please be as candid as you are able — what you share will be handled with care and respect.

A note on confidentiality: At the end of this form, you may indicate anything you prefer not to be shared directly with the person in counselling. Your counsellor will take these concerns into account discreetly, without identifying you as the source.

To complete this form: click each field and type your response. Text boxes expand as you type. Move to the next question when you are ready. Thank you for taking the time to contribute to this person's care.

Your name

Date picker

Relationship Status

Who is your person? What behaviours do you find most challenging — both for them and for those around them?

Is it hard to communicate your concerns to them? If yes, what makes that difficult?

What are the consequences of their behaviour on you/others close to them?

Are there areas such as work, education, or home life, that are being affected by their behaviour?

Are there any concerns or fears you have for this person that feel important to mention?

What do you appreciate most about this person? What strengths do they bring?

What, if anything, may we share with this person from what you have told us?

I affirm this information is truthful and accurate to the best of my knowledge.

Thanks for submitting!

Thank you for trusting us with their care.