Child & Adolescent Enquiry

Please use this form for adolescents age 17 & under.

Some important notes before you complete your form: 

  • For anything other than appointments, please phone 01189 070420.
  • Please note that all sessions are chargeable and Mind Garden does NOT offer reduced fees, free or NHS based services.
  • Other forms are available if you would like couple counselling and adult counselling.

    Your name (required)

    I confirm I am the client or the client's parent or legal guardian.

    Please note we are not able to accept enquiries from third parties (aunts, grandparents, siblings, etc.)

    Your email (required)

    Confirm email (required)

    Phone number

    Is it ok to leave a voicemail?

    Preferred form of contact:

    Please let us know what brings you to seek support at this time. This information is confidential and is reviewed by a senior therapist. It helps us place you with a suitable therapist..

    Have you had therapy before?

    What type of therapy do you require?

    Age of child

    Days & Times You Are Able To Attend Appointments

    Weekday eveningsWeekendsWeekday daytimesWeekdays after school

    Do you have any special requirements to physically access the building?

    Preferred therapist(s):

    How did you hear about Mind Garden?

    If you selected other:

    To help us understand our service demographic, please supply the postcode from which you would be travelling:

    I am happy to be contacted by Mind Garden for feedback on the service provided.

    In accordance with the GDPR, please indicate consent below:

    Yes I understand that my email address will be used for communication regarding the above appointment request. I understand that in order for my appointment request to be processed, the above information will be passed to a suitable therapist(s) who will contact me directly.

    Yes I understand that my information will be kept on file for the statutory period as determined by the British Association for Counselling & Psychotherapy/United Kingdom Council for Psychotherapy/British Psychological Society or equivalent.

    Our Privacy Policy can be viewed here.

    Please note that if you are in crisis you should contact the West Berkshire Crisis Response Team on 0300 365 2000. Alternatively go to your nearest Accident & Emergency or call 999.