Individual Therapy Waiting List Add yourself to our waiting list by completing our pre-treatment assessment form, and we’ll be in touch soon. ← BackThank you for your response. ✨ Name(required) Phone(required) Email(required) What brings you to therapy? Please tick all that apply Addiction Anxiety Bereavement Crime Depression Eating disorder Emotional self-regulation Family Finance/debt Housing Infertility Low self-confidence Marriage Neurodiversity/ADHD OCD Pain Parental alienation Physical health Post-natal depression PTSD Relationship Self-harm Sexual trauma Sexuality Trauma Unemployment Your availability Preferred days for therapy Monday Tuesday Wednesday Thursday Friday Saturday Preferred time 9am-12pm 12pm-2pm 2pm-5pm 5pm-8pm Would you prefer a male or female therapist? Select one option Don't mind Male Female Tell us about your current situation and why you’re reaching out today. Tell us about any therapeutic goals? E.g. what would you like to work on? And what are you hoping to change? Any other details Diversity, Equity, and Inclusion Race/Ethnicity: Asian or Asian British Black, Black British, Caribbean or African Mixed or Multiple ethnic groups White Other ethnic group Religion or Belief: No religion Christian Muslim Jewish Buddhist Hindu Sikh Other Prefer not to say Sexual Orientation: Heterosexual/Straight Gay/Lesbian Bisexual Other Prefer not to say Gender: What is your legal sex? Male Female How do you describe your gender identity? Man Woman Non-binary Other Disability and Health Conditions: Do you have any physical or mental health conditions or disabilities we should be aware of to ensure we can make reasonable adjustments where possible? (e.g., sensory impairments, learning difficulties, neurodiversity). How you came across us Were you referred to us by a third-party service? If yes, what is the name of the service? How did you hear about us? Select one option Search Engine Social Media Friend or Family I consent to this data being stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*(required) SubmitSubmitting form Δ Facebook LinkedIn © 2025 Say More. All rights reserved.
