Enquiry - Psychotherapy + Mindset Coaching
Working together is by application so we can both make sure this is the right fit for us both

I have space for no more than 8 private clients at anytime

All information is private and confidential

Your data is safe with me and will only be used for this purpose. By filling this in you are giving me permission to contact you personally about this.

Sign in to Google to save your progress. Learn more
Email *
Name *
Tell me a little about you....your business/career?
What are you looking for help/support around? Is it a specific issue or a more general area?
Have you worked with anyone else around this issue/area before? If so, what was your experience?
Why is this a good time for you to address this?
Do you have any medical/health issues? Are you taking medication for anything, if so, please give detail.
Do you ever experience low mood, depression or anxiety?
Once you send this to me, I'll contact you via email to arrange a complimentary consultation via Zoom ASAP.
Clear selection
If we both decide we'd like to work together, a personalised package will be created for you based on our conversation. These range between £1,499 - £5,000 per month (with special rates for 3+ months)
Clear selection
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy