Client enquiries

Your (the client's) age*

Please give your (the client's) exact age*

Please let us know all times you (or the client) could be available, including any times during the working day. This will help us find a suitable counsellor as quickly as possible. (If you are looking for face to face counselling please note that our Therapists mainly work Monday to Friday) *

	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday	Sunday
8am
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm

Please note any particular constraints that affect your ability to attend regularly, e.g. irregular work patterns or shifts.

Your (the client's) gender

MaleFemalePrefer not to sayOther

Locations you (the client) can attend. Select all that apply*

MarlboroughNewburyOnlinePhone

Are you (the client) looking for therapy as:*

An individualA coupleOther

Please briefly describe the main issue(s) you (the client) would like to discuss in therapy:*

(Please do not enter names or contact details in this description)0/75

Any specialist approaches or areas of experience needed?

Who will be paying for the therapy?

The clientSomeone elseInsurance

Please give details

Please state which insurer

Do you personally know any Bramham Team Therapists, or is there anyone you would prefer not to work with?

(You can view all Therapists working at Bramham Therapy on the 'Our Team' page of the Bramham Therapy website)

Do you have any other comments, preferences or constraints?

0/100

Therapy enquiry