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Registration Form

Filll in what you can. You can always share more later if needed.

Full name

Email

Address

For invoicing purposes only

Service

Service
A
B
C

About your practice

What's your main approach?

(eg. psychodynamic, gestalt, life coaching)

Key client populations and presenting issues

Whether currently working with or would like to work with

Pricing and location details

List of qualifications & training

You can also share any current online profiles

For your website

Your photo & any professional logos (BACP etc.)

Style preferences for website

Colours, layouts, symbols - feel free to share a website you like

Add any relevent pictures or screenshots here

About you

Anything else you would like me to know about you - including accessibility needs.

I confirm that I have read and agree to the terms of the full contract

https://drive.proton.me/urls/QEBGBY23KM#UEjoQdmXKTMn
I confirm that I have read and agree to the terms of the full contract
Privacy notice - Your information will be stored securely, used only for this service, and never shared or sold to third parties.