Book your Initial
Therapy Session

It's completely normal to feel unsure or hesitant.

You might not be sure what you need yet. You might just know something doesn't feel right.

This is simply the first conversation - a space for you to talk through what's been going on and see if this feels the right support for you.

What to Expect

The booking form should take you no longer than 5 minutes to complete
I personally review every enquiry and will get back to you
We talk through what's been bringing you to therapy
You can share as much or as little as you feel comfortable with
We begin to explore what you'd like support with
You can ask any questions about the process
If I'm not the right therapist for you, I will let you know

Fully confidential. No pressure.

No expectations

Session details

Duration: 60 mins

Format: Teams video call or telephone call

Confidential and professional

Flexible, ongoing or short term support

Session Request Form

Full Name*

This field is mandatory

Date of Birth*

This field is mandatory

Age*

This field is mandatory

E-mail*

This field is mandatory

The e-mail address is invalid

Address including postcode*

This field is mandatory

Telephone:*

This field is mandatory

Preferred method of contact? Email or telephone?*

This field is mandatory

Emergency Contact (Name & telephone number)

Preferred method of sessions? Telephone or Teams Call?*

This field is mandatory

Name and address of the GP Practice registered with.*

This field is mandatory

Have you discussed your mental health with a GP recently?

Please state if you have had an official diagnosis for your mental health from your GP or Psychiatrist at a hospital and what that diagnosis is and when it was given.*

This field is mandatory

Are you currenttly receiving support and under the care of a mental health crisis team in your area?*

This field is mandatory

Are you currently taking medication for your mental health? If yes, please state which drug, the dosage and how long you have been taking them.*

This field is mandatory

How long have you felt unwell with your mental health?*

This field is mandatory

Have you sought help before? If so, where from, what type of therapy did you receive, and how long did you receive it for? *

This field is mandatory

Are you receiving therapy or support currently with another provider? How long for and what type of support?*

This field is mandatory

Did you feel the therapy you had in the past was successful?*

This field is mandatory

Please give details of what brought you to seek help today. The more detail you give the better. Thank you.*

This field is mandatory

Have you suffered trauma, in the past or recently? Can you tell me briefly what that involved and if you feel it is related to how you feel now?*

This field is mandatory

If yes: is your past or recent trauma something you would be willing to discuss in therapy?*

This field is mandatory

Sessions with me are collaborative. Are you committed to engaging in homework if required as part of your recovery?*

This field is mandatory

Are you willing to potentially push past your comfort zone in order to build mental and emotional resilience?*

This field is mandatory

What is the most important aspect of your mental health that you would like to work on?*

This field is mandatory

What is your ultimate goal regarding the outcome of your therapy?*

This field is mandatory

On a scale of 1 to 10, how bad do you feel today? (1 = very low, 10 = very good)*

This field is mandatory

If you are struggling with menopause symptoms at work or on a day to day basis, would you like support with this?

I work within strict GDPR guidelines in terms of confidentiality. Confidentiality would be broken if you are suicidal, have a plan in place to end your life or deemed a danger to others or yourself.

Do you consent to the above GDPR rules of breaking confidentiality? Unfortunately if you refuse I will be unable to provide therapy for you.*

This field is mandatory

Please indicate where you heard about Caroline Rothwell Therapy.*

This field is mandatory

I hereby agree that this data will be stored and processed for the purpose of establishing contact. I am aware that I can revoke my consent at any time.*

* Indicates required fields

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Thank you for your enquiry. We will be in touch soon to arrange your first free 30-minute assessment.

Book your InitialTherapy Session

What to Expect

Session details

Session Request Form

Book your Initial
Therapy Session