Consult session for Multimodal Therapy
This form aims to find out more about your mental and emotional needs before contacting you for a complimentary consultation. The information will help us to assess your suitability for our therapy programmes, and to be referred for alternative supports.

Please note that this complimentary session is offered on a needs basis. It is not a therapy session, but an opportunity to understand more about arts based therapies for emotional healing. Kindly fill in this form if you are genuinely seeking therapeutic support.

For research or interest based inquiries, please email Thank you!
My name is... (this will be kept confidential) *
This consult is for... *
Age range *
I am seeking... *
Please tick the statements that are relevant for you. This will remain confidential and for our therapist's reference only. *
When do you hope to begin therapy sessions? *
Would you prefer individual or group therapy? *
My parents are supportive of me seeking therapeutic support *
I am comfortable asking my parents for monetary support for therapy *
I am willing / have ability to pay for therapy sessions *
If your answer to the above question is 'No', kindly share your reasons.
I understand that the complimentary consult is not a therapy session, and there will be no follow-up unless therapy sessions are engaged *
Please provide 3 preferred dates and times for the consult, starting 22 Jan 2021. *
Please include me in Acting Up's mailing list to be updated on upcoming events, workshops and therapy sessions *
Any other information you'd like us to know?
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