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First name*

Last name*

Email*

Phone

Address

GP Details

How did you hear about the relating space?

Counselling Directory

COSRT register

BACP register

The Relating Space Website

Therapist Recommendation

Other/ please state

What service/s have you used, or are you interested in using?

Relationship Therapy

Psychosexual Therapy

Family Counselling

Coaching

CBT for Menopause Group

Supervision

Forest Therapy

Other/ Please state

Do you consent to The Relating Space Contract 2026

Yes

Please (re)send- not received

Adjustments needed/ please state

What have you found most useful in your sessions? -If new please state what has helped you most in previous counselling/ therapy spaces.

What have you found less useful or challenging in your sessions? What has helped- or could help- navigate this? -If new please state what has challenged you most in previous counselling/ therapy spaces.

What do you want/ hope for (next) from your sessions ?

Do you consent to any of the above being used anonymously in testimonial on the relating space website-?

Yes

Please include the below testimonial

Other/ please state any omissions

Testimonial space

Any other reflections

The Relating Space,

Relationship Therapy, Psychosexual Therapy; Relational Coaching

Camilla Fadel 2022

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