Psychotherapy, Counselling & Coaching

Your life. Explore.
Home     About therapy     Therapy online     In the news     Making an online payment     Contacts      
Registration form

You can complete your registration form here. If you would prefer to receive a Word version to complete later, please contact me.

Full name *
Date of birth / age
Contact telephone number *
Mobile number (if different)
Email address
Please retype your email address
Address (include postcode) *
Preferred venue *
Experience of previous psychotherapy / counselling? *
Why are you considering therapy now? *
Once bookings have been confirmed, any missed or cancelled sessions will be charged for unless seven day's notice is given. Leave the box ticked to acknowledge you accept these conditions.