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Esther Group Intake Form

Our specialised program provides confidential support and evidence-based interventions for women who have engaged in family violence and are committed to making positive changes in their lives. We understand that taking responsibility for harmful behaviour requires courage, and we offer a safe, non-judgmental environment where participants can develop healthier ways of managing emotions, stress, and conflict within their relationships.
Through individual counselling and group sessions, participants learn practical skills for communication, emotional regulation, and conflict resolution while working to rebuild trust with their families. Our approach emphasises accountability, personal growth, and breaking cycles of violence to create safer, healthier family environments for everyone involved.

Marital Status

Gender

Occupation

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Academic Background

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Mental Health
Medical Health
Admission to Sandilands Rehabilitation Centre
Yes
No

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Do you currently have a history of drug usage?
Do you have a history of drug usage (in the past)?
Have you abused anyone?

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