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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? (e.g. weekday mornings, Wednesday evenings, Thursdays from 3–5pm)

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?

What are you hoping to get out of therapy?

Anything else you'd like us to know?

Emergency & GP Details

We need these details before therapy can begin, for safeguarding and emergency purposes. 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.

GP Name or Practice Name

GP Practice Address

Emergency Contact Name

Relationship to you

Phone Number

How did you find us?

Google Search

AI Search

Word of Mouth

Facebook

Instagram

Flyer or Event

Podcast

Other

Referral Code

I have read and agree to Mothering Minds' Terms of Service, Privacy Policy, Cancellation Policy and Liability Waiver, and I confirm I am aged 18 or over

Yes

Thank you! Now check out below to book.

Once your payment has come through, we will match you with a therapist and offer you suitable time-slots for the assessment. 80% of our clients are matched within 48 hours, but please allow up to four working days.