Request For Services

If you are interested in accessing my services, please complete and submit the following form.

The information provided here will enable me to better assist and guide you towards accessing services based on your needs and my availability & areas of professional focus.

 

First Name *
Last Name *
Email *
Mobile Phone *
I am interested in:*
Individual Psychotherapy (adult, 18 years+)
Couple Therapy
Clinical Assessment / Psychological Consult (maximum 2 appointments)
Psychedelic Support
Vegan or Animal Rescue Worker mental health support
Workshop / Programme
Public Event or Appearance
Other:
Other: Please Specify *
Were you referred to me?*(e.g. another psychologist / health care professional / existing patient)
No
Yes
I was referred by *
Provider preference*
I am specifically interested in seeing Dr Bridget due to her particular professional areas of focus and experience
I don’t specifically prefer to see Dr Bridget, I would also be satisfied to see one of her colleagues.
Additional Information *

I would like to be added to the Rewilded Being mailing list for upcoming events e.g. workshops, groups, programmes.

Accept Terms *

Please note that all information provided in this form will be processed and used only in so far as it applies to your enquiry regarding accessing my services. None of the information provided by you will be used for any other purpose without your consent.

Submit

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