Book a Therapy Session

Name*

Email address*

Phone*

Please provide a brief summary of (i) your current difficulties, and (ii) your goals of seeking support: (n.b. a full psychological assessment will occur prior to therapy)*

Your appointment preferences* Your appointment preferences* Face-to-face (London/Edinburgh) Remote (online/phone) Both

If face-to-face, please indicate your preferences for appointment location* If face-to-face, please indicate your preferences for appointment location* London (Victoria) London (Islington) Edinburgh

Please indicate your preferences for the therapist's gender* Please indicate your preferences for the therapist's gender* Male Female No preference

Indicate your availability to attend appointments (please select all possible options)* Indicate your availability to attend appointments (please select all possible options)* Mornings (weekday) Afternoons (weekday) Evenings (weekday) Weekends

Please indicate how you will be funding* Please indicate how you will be funding* Self-funding Insurance policy

If using an insurance policy, please state the named insurer and provide your policy number. N.B Please ensure that you have pre-authorisation in place before attending your initial session*

Other comments / enquiries

How did you hear about us? How did you hear about us? Health professional referral Therapist directory e.g. Psychology Today Employer Friend / relative Search engine Facebook Twitter Instagram Health insurance company Other