Enquiry Form 
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Email *
2. Your Name *
3. Please let us know what are you looking for from WTP? 
4.  Please let us know something about your reasons for seeking support and anything else that you wish to share with us. *
5. For those seeking therapy only: 

Our therapists have clinics on Thursdays and Fridays. Please can you select which slots you could potentially attend.  

Please tick all that apply.  
Timezone is UK - GMT
Early Morning
Mid Morning
Lunchtime
Afternoon
Early Evening
Monday
Tuesday
Thursday
Friday
6. For those seeking therapy - Is there a particular therapist or coach you are drawn to working with or would you like a recommendation based on your situation from our Clinical Director ? 
7. Today's Date  *
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8.  Your Date of Birth *
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9.  Country of Residence  *
10. If you live in London, UK  please could you let us know which Borough you live in currently? 

(This is to ensure there is no conflict of interest for our clinicians who also work into London based NHS services)
11. Are you currently open to any other services that are offering you support ? This may be either within the public or private sector.  *
Required
12.  Please tell us about the support you are currently receiving from other services (if applicable) 
13. Would you like to join the mailing list for news about new courses and group offerings for professional women from Women's Therapy Practice ?

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14. Finally - please can you let us know how you heard about WTP. *
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15. Your Privacy 
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Many thanks for taking the time to complete this.
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