Marriage Counselling & Mediation Intake Form

By submitting this form, you confirm that you:

• Understand this is a confidential, faith-based service guided by Qur’an and Sunnah
• Accept the £90 fee for the first session
• Understand the second session (joint) is available for £80 — payable now or later
• Accept that all fees are non-refundable, whether one or both parties attend or not
• Accept responsibility for inviting your spouse/partner (we can support, but cannot guarantee or arrange their attendance).
• Will remain respectful toward the counsellor and the process
• Understand the counsellor's role is to facilitate, not to judge, enforce, or assign blame
• Know that the service is not legal, emergency, or psychological care
• Confirm there are no legal restrictions preventing communication
• Accept that any abusive, aggressive, or disrespectful behaviour may result in immediate termination with no refund
• Consent to MySheikhOnline storing your information for service purposes
• Acknowledge that these terms may be updated or adjusted at any time