New Clients

Potential clients should complete the new client form.
You will then be contacted to arrange an Initial Assessment.

Note: All clients must complete the form before an assessment can be booked

Form Securely Transmitted

Please check your email including junk folders for next steps

Title *

Full Name (Including Any Middle Names) *

1. WHAT IS YOUR DATE OF BIRTH? (8 DIGIT FORMAT) *

2. HOME ADDRESS (PLEASE INCLUDE YOUR FULL ADDRESS) *

3. YOUR EMAIL ADDRESS *

4. YOUR MOBILE NUMBER *

5. REGISTERED GP PRACTICE/SURGERY *

6. WHICH ARE YOU GETTING IN CONTACT ABOUT? (Select any that are applicable) * Relationship TherapyPsychosexual TherapyRelink RetreatsCoaching & TuitionPlatelet Rich Plasma (PRP) TherapyOther

7. HAVE YOU HAD THERAPY OR USED SERVICES SUCH AS THESE PREVIOUSLY? *

8. ONLY IF APPLICABLE, PUT YOUR PARTNER'S NAME HERE SHOULD YOU WISH THIS TO BE A COUPLES PROCESS. (Leave blank if individual therapy)

ABOUT YOU

Please elaborate as much as you can below to help plan your assessment

9. WHAT BRINGS YOU TO RELINK THERAPY? (PLEASE ELABORATE AS MUCH AS YOU CAN AS THIS HELPS WITH PLANNING) *

10. IS THERE ANYTHING ALSO YOU WOULD LIKE TO SHARE AT THIS TIME?

By submitting this form I confirm I agree entirely to Relink Therapy's Policies & Procedures.

Review the official Policies & Procedures documentation ↗

11. WHERE DID YOU FIND OUT ABOUT RELINK THERAPY? (GOOGLE, WORD OF MOUTH ETC) *

Existing Clients

You may use the Appointment Portal to book your clinic appointments.

You can book 50 or 90 minute sessions.

Note: This is only accessible by clients that have already attended an initial assessment.

Existing Client Portal