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

    Phone Number

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

    Your Email

    Confirm Email

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

    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?

    Age of child

    Days & Times You Are Able To Attend Appointments:

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

    Do you prefer a male or female therapist?

    If your preferred gender is not available, would you be willing to consider the alternative gender?

    Preferred therapist(s)

    How did you hear about Mind Garden?

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

    In accordance with the GDPR, please indicate consent below:

    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.