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Private Individual Referral

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1About You
2Contacts
3Referral
4State of Wellbeing
5Sessions
6Referrer
7Submit
Initial Appointment/Consultation £50. If you are a suitable candidate for therapy you will start with a commitment of six sessions which is £399. This is payable in full in advance following initial consultation. If your therapist isn't suitable for any reason you can arrange another initial appointment with another practitioner. We do not take insurance or offer a payment plan currently. We have a strict 48 hour cancellation policy, your session will be counted if the session is cancelled within 48 hours of your planned session. We also contract you to be free of substances for 12 hours prior to your session time. We offer both in person and face to face. You will be contacted following this completed referral to arrange a suitable time and date for your initial session - this may sometimes be from a withheld number. We will try and leave a message, we will also email (check your junk just in case) and SMS. Please respond promptly as appointments do go quickly.
Please fill in all fields with the referred's details - you will have an opportunity to fill in your details before submitting.
Name*
DD slash MM slash YYYY
Address*

Your GP

Surgery Address

Your Emergency Contact

Emergency Contact Name*
PAYMENT IN ADVANCE OF SESSION (48HOURS) **COSTS PER SESSION FACE TO FACE £65** COSTS PER SESSION ONLINE £55** Please note that this is a paid service. We operate on a pay-as-you-go basis, meaning you pay for each session at least 48 hours before your scheduled appointment. Additionally, we enforce a 48-hour cancellation policy. Upon arranging your first appointment, we will collect your card details, and payment will be charged for late cancellations or no-shows. The costs for private counselling and CBT remain the same. Our online sessions are available from 8 am to 9 pm and are conducted by highly qualified and experienced therapists. Face-to-face sessions are held in Glasgow or East Kilbride, also from 8 am to 9 pm, and are facilitated by skilled professional therapists. Please also be aware that we offer a discount for bulk purchases, so feel free to discuss this option if you're interested in buying a group of 6 sessions or more.

For urgent mental health support please contact your local GP or NHS 24 on 111.

Or contact one of the following crisis services:

Samaritans: 116 123
Breathing Space: 0800 83 85 87
Scottish Women's Aid: 0800 027 1234
Rape Crisis: 08088 01 03 02

What would be your session preference?*
Select all options that may be suitable.
When would be a good time for your sessions?*
Select as many as you wish
Can you advise if you will be able to take a regular weekly slot at an agreed day and time.
Can you advise if your preference would be weekly, fortnightly or monthly sessions.
Which type of service are you looking for?
Consultation*
We will call you to discuss your referral and book your first appointment. You can use this time to ask any questions with the therapist who calls you. Please list when generally is good for us to give you a call. (Please also note - we generally call from a withheld number, we will leave a message.)
Referrer Name*
Consent of the Referred*
Personal Data Consent*
Untitled
This field is for validation purposes and should be left unchanged.
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