Bookings & Enquiries

Please complete the following Enquiry Form if you would like to obtain further information or to make an appointment.


Enquiry Form


Name:

E-Mail:

Telephone:


Your area(s) of Interest:
Counselling
Hypnotherapy
Psychotherapy

Smoking Cessation
Corporate Services
Stress Management
Anger Management
Weight Control and Healthy Eating
Mediation
Assertiveness Training
Critical Incident Stress Debriefing
EMDR

Other area of Interest – please specify:


Enquiry Details:


Your preferred appointment location:
Piccadilly Circus
St James’s
Old Street
Vauxhall
Twickenham
Harley Street
Teddington

Other Location – please specify:


Your preferred contact method:




What is your preferred contact time?:
MorningAfternoon Evening

What is your preferred contact day?:
Monday Tuesday Wednesday Thursday Friday

Where did you hear about us?:




Other – please specify:






Please untick this box if you do not wish to be included in our regular newsletter.





Please note that all personal data is kept securely in accordance with the Data Protection Act and will not be passed on to any third parties.