1:1 Therapy Support 

Thank you for your interest in therapy support with HeadSync Therapy Hub.

This form helps us understand how to contact you and what kind of support you’re looking for.

You don’t need to share anything you’re not comfortable with and there are no right or wrong answers.

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Full name *
Email address *
Phone number
How would you prefer to be contacted
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Age Range
  What has brought you to consider therapy at this time?   
Which of these feel relevant to you right now? Pick as many or as little as you need. 
What type of support are you interested in?
Are you currently receiving therapy elsewhere?
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Preferred session format
  Availability  
  How did you hear about us?  
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12. Consent to be contacted
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