All information on this form will be kept strictly confidential to The Blue Dawn's trusted volunteers and will not be shared with anyone else without your explicit consent. We take your privacy very seriously.
Please tell us your name (or how you'd like us to call you)
Phone number where we can call or message you
Your email address
Please tell us the location of your practice (Name of your city/town/village)
Prefer to be contacted by
What is your preferred therapy method (CBT/Narrative/DMT etc)
If you have a preferred age bracket for clients, please mention it below
Can you let us know your session charges that you would be offering to us/if there is any sliding scale rate?
If you would like to be associated with us in any other way, do let us know below
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