Couples Enquiry Form

Please use this form if you looking for couples therapy.

Some important notes before you complete your form:

  • Our priority is confidentiality. Enquiries from third parties (friends, parents, etc.) will be refused.
  • Other forms are available if you need adult therapy (18+) or child & adolescent therapy.
  • Please note both parties must be in agreement with having therapy for it to go ahead.
  • For anything other than appointments, please phone 01189 070420.

    Your Name

    Phone Number

    Your Partner's Name

    Your Email

    Confirm Email

    Is it ok to leave a voicemail?

    Preferred form of contact

    Please let us know what brings you to seek support at this time. This information is confidential and is reviewed by a senior therapist. It helps us place you with a suitable therapist.

    What type of therapy do you require?

    Days & Times You Are Able To Attend Appointments:

    Do you have any special requirements to physically access the building?

    Do you prefer a male or female therapist?

    If your preferred gender is not available, would you be willing to consider the alternative gender?

    Preferred therapist(s)

    How did you hear about Mind Garden?

    I am happy to be contacted by Mind Garden for feedback on the service provided.

    In accordance with the GDPR, please indicate consent below:

    Please note that if you are in crisis you should contact the West Berkshire Crisis Response Team on 0300 365 2000. Alternatively go to your nearest Accident & Emergency or call 999.