New Patient Form
Thank you for getting in touch with the Parenthood In Mind practice team. We are confident we can help you but need some initial information to help us put you in contact with the right therapist.
A copy of our privacy notice can be found on our website:
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Where are you based?
Please note we cannot accept perinatal cases (currently pregnant or infant under 1 year old) if you are based outside of the UK or EU
How did you hear about the Parenthood in Mind practice?
Recommended by a friend
Referral by a psychiatrist
Referral by a GP
What type of therapy are you looking for?
Do you have a preference of therapist or type of therapy?
If you are looking for support for your child, please state their age
If you feel able to, please give us a brief outline of the reasons you are seeking support at this time
Are there any other professionals involved in your care (eg psychiatrist, perinatal mental health team, midwife, social worker?)
If yes, please provide their contact details. (Please note, we made need to contact them but will always get your permission to do this).
Are you currently pregnant?
If yes, please state your EDD
Please note that currently, most sessions offered are online/on the phone but please state your preference below
Face to face
On the phone
Online (zoom, skype or similar)
Mix of the above
When are you hoping to have these sessions?
Early Evening (5-7pm)
Late Evening (7-9pm)
Or are there specific days or times that suit?
Fees for therapy with the Parenthood in Mind practitioners will vary according to the therapist, location, length and type of therapy. Most practitioners charge between £90 and £120 for individual therapy and £120 and £160 for couples.
How will you be funding sessions?
If health insurance, please state which company
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This form was created inside of Parenthood in Mind.