0%
Worksheet

Confidential Enquiry Form - For Therapy

1. ➜
2. ➜

Hello! Thank you so much for showing interest in having some therapy with me.

3. ➜

I would love to know more about you so that I can create a bespoke therapy experience just for you.

4. ➜

These questions will help me to understand where you are in your life right now, and how you would like your future to be. Please answer them as openly and honestly as possible. I will treat your responses with the upmost care, respect and confidentiality.

5. ➜

Full name

6. ➜

Please can you briefly describe your current difficulties, and what you are hoping for from therapy

7. ➜

Best telephone number to reach you on

8. ➜

Best email address to reach you on

9. ➜

Preferred method of contact

10. ➜

Best times to call (if contacting by phone)

11. ➜

Many thanks for completing this form - I will be in contact as soon as possible to discuss your requirements and arrange a session.