Is CBT Therapy Online Right for you?
This is the screening you need to complete to access to our services. We want you to get the best help so that your needs are met appropriately.

PLEASE READ EACH OF THE FOLLOWING QUESTIONS CAREFULLY.
Sign in to Google to save your progress. Learn more
Your email addres to receive the result *
Are you over 18 years old? *
1 point
Do you have access to a smartphone, computer, laptop, tablet with a videocamera installed? *
1 point
Are you comfortable using your own computer e.g. creating documents, sending and receiving emails, etc? *
1 point
Are you comfortable using videoconferencing technology such as Skype or Vsee? *
1 point
Are you willing to reveal information to your therapist about yourself, your feelings and identity?   *
1 point
Would you have 50 minutes of your time without any interruptions to have the therapy session once a week?   *
1 point
Our fees are £80 per session (with John) and £90 (with Sylvia), payable after every session. Are you comfortable using bank transfers to pay for your therapy fees? *
1 point
Do you agree with our confidentiality policy ?"My therapist and I agree to keep confidential all information exchanged, disclosed by email, videoconferencing, or telephone. As my therapist will not share any information about me to any other party, I will not disclose to a third party what we may have discussed in therapy, use any audio/video-recording to show other people, or upload it on the Internet. Our policy of confidentiality is just as much as for the therapist as it is for me regarding what we share. I will NOT show or display any audio/video material produced during my sessions to any third party. I will only use those materials for my own personal use. Breaching this condition would not only be a breach of this confidentiality policy but would also make me liable for any prosecution that may arise due to copyright infringement. Any materials used for therapy, including sessions recorded, are property of Anapsys Counselling Services. There are only three boundaries to confidentiality applicable to any psychotherapy practice: 1) If my therapist considers that I am in imminent and significant personal danger which may compromise my own safety during the course of the therapy 2) If I disclose information about having harmed a third party e.g., physical abuse to my own children 3) If I confessed having committed a crime punishable by law within the territory Anapsys provide their services (UK). In any of these cases, the proper authorities e.g., your doctor or any other appropriate person, will be notified by my therapist if he or she deems that action becomes necessary." *
1 point
 Are you a victim of violence in a relationship at present? *
1 point
Are you being violent with your partner or children at present? *
1 point
 Are you feeling suicidal at present? *
1 point
Have you ever attempted to commit suicide in the past? (not just having suicidal thoughts?) *
1 point
Are you currently dealing with an eating disorder (e.g. bulimia, binge eating or anorexia?) *
1 point
Have you ever been diagnosed formerly by a mental health professional with schizophrenia, bipolar disorder, or psychosis? *
1 point
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy