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Book your Couples Assessment

By completing this form, you consent to Mothering Minds collecting and processing your personal and health-related information to match you with a therapist and provide our services. Your data is handled in line with UK GDPR. See our Privacy Policy for details.

Your Names

Your Email Addresses

Your Phone Numbers

When are you generally available for sessions?

While we will do our best to match you with a great fit therapist who also has overlapping availability, we can't guarantee this - especially when it comes to evenings and weekends. We will always be in touch with you if this happens and offer you alternative openings or matches.

Any specific dates or times that would work best for you for this session?

Which of the following best describes where you are right now? (Select all that apply)

Deciding whether to have children

Trying to conceive (TTC)

Currently pregnant

New parents (baby/babies aged 0–12 months)

Parents of a toddler or young child

Parents of multiple children

Experiencing pregnancy or baby loss

Other

What brings you to Couples Therapy?

Anything else you'd like us to know?

Emergency & GP Details

We need these details for safeguarding and emergency purposes only. We won't contact your GP or emergency contact without your consent, unless there is a serious risk to your safety or someone else's. See our Confidentiality Policy for more.

Home Address

GP Name or Practice Name

GP Practice Address

Emergency Contact Name

Relationship to you

Phone Number

How did you find us?

Google Search

Google Ad

AI Search

Family and Friends

Social Media

Press or Podcast

Referral: Company, professional or service provider

Other

We have read and agree to Mothering Minds' Terms of Service, Privacy Policy, Cancellation Policy and Liability Waiver, and we confirm we are both aged 18 or over

Yes

Subscribe to our newsletter and get support and insights on parental mental health straight to your inbox?

Yes

Thank you! Now check out below to book.

Once your payment has come through, we will match you with a therapist to schedule your assessment. 90% of our clients are matched within 48 hours, but please allow up to four working days.