Therapy Enquiry Form

This form helps me get a sense of what’s bringing you to therapy and how I can best support you. Please only share what you feel comfortable with; there are no right or wrong answers.

Your Details

First name

Last name

Preferred Name (if different)

Date of Birth

Day

Month

Year

This helps me understand your stage of life and ensure suitability for therapy.

Email Address

Phone Number

Preferred way to be contacted

Email

Phone Call

What’s Bringing You to Therapy?

This helps me understand what kind of support you’re looking for and how I can best help.

Please indicate which service you are interested in:

1:1 Therapy

Couples Therapy

Group Therapy

What has led you to seek therapy at this time?

You might like to share a few sentences about what’s been happening or what you’re hoping to explore.

How long have you been experiencing these difficulties?

Less than 6 months

6-12 months

1-3 years

More than 3 years

Have you had therapy before?

Yes

No

Are you currently receiving any other form of support (medical, psychiatric, or couples/family therapy)?

Yes

No

Your Preferences

You have the option to book sessions straight away, or to have a free 15-20 minute Introductory Call. This call isn’t a therapy session, it’s a space to meet, ask questions, and get a feel for whether working together feels like a good fit.

Book Sessions

Book an Introductory Call

Please indicate how you would prefer to attend sessions

In-person (Fitzrovia, London, W1) on a Tuesday or Thursday only

Online via Zoom (Monday-Friday)

Please note: Limited in-person sessions are available. If you select this option and no slots remain, you will be offered online sessions until an in-person spot becomes available.

Preferred days and times for sessions

Please provide a variation of different days and times that would be suitable for us to meet on a weekly basis. I will then check my availability and either book you in, or alternatively suggest other times as near to your preference as possible.

Please note: the only days that I work in-person are Tuesdays and Thursdays. I work online throughout the week.

Before You Send

Just a couple of final details before submitting your enquiry.

Is there anything you’d like me to know that would help me understand you better before we meet/speak?

How did you find out about my services?

I understand that submitting this form does not create a therapeutic relationship, and no therapeutic relationship will exist until I have signed the Therapeutic Agreement.

I understand that 1:1 therapy sessional fees operate on a sliding scale, currently between £90 to £120 per session. Invoices are sent in advance of each month, and the entire payment is due by the beginning of the month.

Please select a sessional fee within the abovenamed sliding scale, choosing a fee that is fair and representative of your, or the bill payer's, current financial situation and household income.

I consent to my information being used for the purpose of arranging therapy.

I confirm that I have read through the FAQs, and feel clear and comfortable moving forward.

I understand that my data will be stored securely and confidentially in line with GDPR.