Therapy Contact Form
This form helps us to plan next steps and to ensure that we are the best fit for you.  

You can find out more information about whether therapy from Beyond the Clinic Room might be right for you here. 

If having read this you feel Beyond the Clinic Room could be for you, please fill in your details below so we can contact you to discuss your needs.

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Today's Date  *
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Name *
Date of birth  *
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Email address *
Please could you briefly describe what you are struggling with? *
Have you had therapy previously?  *
If so, could you briefly describe what therapy you have tried before and how you found this? 
Are you currently seeing another mental health team/mental health professional? *
Are you looking for face to face or online therapy? *
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Are you looking to self fund therapy or fund via insurance?  *
How did you hear about Beyond the Clinic Room? *
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Thank you very much for filling out this form. We will be in contact with you as soon as possible. 
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