Name 

What is your collective/institution called?

Location

Where do you do your work? Please enter your city, country, but also note if you have flexible locations, such as squares, cultural centres etc. 

Self-describe in up to 250 words

Would you like to share some core information on your collective? 

We have in mind things such as: your mission statement, key elements of your history (including when you started), your innovations in terms of psychoanalytic setting, theoretical influences that are important to you, or anything else that is at the heart of your work. 

People you work with

What population do you offer psychoanalysis to? Are there particular categories that are the focus of your work?

Modes of payment

How would you characterise the form of payment your work with in your collective? Free? Low cost? Sliding scale? Feel free to expand on modalities of payment. 

Clinical modalities

What modalities of clinical work do you work with in your collective? Is psychoanalysis practiced alongside other modalities? Which are they?

Institutional links

Is your collective/institution formally connected to a psychoanalytic training institute/organisation? Which one?

University links

Is your collective/institution formally connected to a university? Which one?

Open at present?

Are you currently (2023) open to taking on new patients?

Website 

What is your website, if you have one, or, if not, what is the best way that colleagues and patients might find more information on your work?

Contact email

Facebook page

Twitter page

Instagram page

Translation

May we translate your self-description to English, if this was written in another language?

Consent

May we share this information on the FREEPSY website, under the category ‘The Free Clinics Network’?