Book a therapy session

Please kindly use the form below to book a therapy session with us and a member of our administration team will respond to you as soon as possible.

We are not a crisis service. Please do not complete this form if you are experiencing a mental health crisis.

For crisis support, please contact the Mental Health Crisis Line on 0300 456 8342, the Samaritans on 116 123 or your GP. For immediate support if you cannot keep yourself safe call 999 or go to A&E.

 

Self Referral Form

Client Information

Who is the Client?
Client Name
Client Name
First
Last
Your partner’s name (for Couples Therapy only)
Your partner's name (for Couples Therapy only)
First
Last
Gender (Client)

Your Therapy Requirements

Do you wish to see your therapist face to face or online?
Please indicate your preferences for the therapist’s gender
Please indicate the type of therapy you are looking for.
Please indicate how you will be funding

Your Availability

The more flexible you can be, the easier it will be to find the right therapist for you.

Caring for your safety

Other

How did you hear about us?