Psychotherapy Enquiry Form
GPDR notice:  Any information such as your personal details will be stored securely. They will be kept confidential and only used to ensure service provision, in accordance with the GDPR legislation and UKCP. Please let us know if, at any point, you would like to have your details removed. 
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Before you send the form...
Sessions are only available throughout the day on Wednesdays. 
All my work is supervised by an experienced UKCP Registered supervisor.  My work adheres to the UKCP and Gestalt Centre Ethical Codes. 
Fees are £100 per session online or in person from my clinic near King's Cross Station. I work long and short term (12 sessions minimum).
Title/Gender Pronouns *
What is your name and surname?  *
What is your private email address?  *
What is your date of birth? 
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Preferred contact number  *
How would you prefer to be contacted?  *
Occupation (Optional)
Briefly describe what has made you consider psychotherapy at this time:  *
Please tell me if you have been diagnosed with a medical condition you think I should know about. (Optional)
How would you prefer to work?  *
Sometimes sessions are audio recorded for supervision  purposes, to ensure you are getting the best possible care. Would you be open to this? (Recordings are anonymised and only kept for the minimum amount of time required for supervision, and are stored securely in compliance with GDPR requirements). I can provide more information on request.  *
Anything else you would like to share? 
Thank you. 
I will get back to you within 14 days to discuss next steps. 
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