Registration - Affair Recovery

Full Name*

Partner's Full Name (if attending joint consultations)*

Phone Number *

Email*

Consent to contact - text, email or phone re: appointments, referrals or information.

Which service are you registering for?

Affair Recovery & Infidelity Trauma - Individual Consultation

Couple's Affair Trauma Recovery - Couple's Consultation

Betrayed Partner Parenting - Individual Consultation

Parenting Together Through Betrayal - Joint Consultation

Are you linked to any other counselling, mediator or support service?

Yes

Name/Professional Field of this support please.

Please share 1-3 goals you have for working with The Seamless Blend

Please share any relevant additional information.

How did you hear about The Seamless Blend?

Facebook

Instagram

TikTok

Referred by Previous Client

Family Mediators

Psychologists

Employee Assistance Program

Workplace People and Culture

Other Professional*

Google Search**

*If other Professional recommended TSB please provide their name

**If Google search, which search words did you use?

I understand prices are displayed in Australian dollars (AUD). International bookings may incur an additional AUD $30 processing fee.

I understand The Seamless Blend do not provide crisis care or psychological services, but offer evidence-informed, trauma-based guidance; driving a strengths-aligned, child-focused, family-centred coach model.

I agree to The Seamless Blend's Privacy Policy

I accept The Seamless Blend's Terms & Conditions

0423 325 905

admin@seamlessblend.com.au

ABN 13 273 843 274

Terms and Conditions

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