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Request for Exploratory Therapy
Please check our online directory of therapists first. If you do not find someone suitable there, please fill out this form in order for us to try and match you with an appropriate therapist.
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Name
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Your answer
Your email address
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Your answer
Age of the person for whom therapy is being sought.
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Your answer
Where is the person located? Please be as specific as possible. What country? City? State?
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Your answer
Is the person open to online therapy?
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Yes
No
Please tell us as much information about the prospective client as you wish so that potential therapists can judge whether they might be a fit. Although we would appreciate as much information as possible, please avoid sharing identifying details in order to protect your privacy.
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Your answer
Do you give us permission to share this information with clinicians in Therapy First in order to search for a potential therapist?
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Yes
No
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