Couples Enquiry

Please read the information below before completing the form:

  • We cannot accept enquiries from third parties (children, relatives, etc.).
  • Enquiries for child therapy (under 16’s) or family therapy should use the Child/Family Enquiry Form. 
  • For enquiries about anything other than appointments do not use this form, please phone 01189 070420.
  • During the COVID-19 Crisis we ask that if you are at all unwell or have been in contact with someone who may have the virus, that you not attend the centre. Online therapy is available with some of our therapists.

Mode Of Therapy (required)

Your name (required)

Your partner's name (required)

Your email (required)

Confirm email (required)

Your partner's email (required)

Confirm partner's 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.

What type of therapy do you require?

Days & Times You Are Able To Attend Appointments
Weekday eveningsWeekendsWeekday daytimes

Access requirements? [accessrequirements]

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

Do you prefer a male or female therapist?

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:

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 0300 or 0300 365 9999. Alternatively go to your nearest Accident & Emergency or call 999.