Begin your journey by completing our consultation form so we can learn more about you! Step 1 of 9 11% Who is the therapy for?(Required) Older Adults (65+) Adult Young person between 12-17 Child between 0-11 Couples Therapy Family Therapy Please could you provide some information about you?Name(Required) First Last Email(Required) Phone(Required)Age of the child(Required)Relationship to child(Required)Please confirm you have parental responsibility for the child(Required) Please confirm you have parental responsibility for the child.(Required) Is this for therapy or an assessment?(Required) Therapy Assessment (eg. Autism assessment, ADHD assessment, Cognitive/Educational assessment, other assessment) What kind of assessment?(Required) ADHD assessment Autism assessment Cognitive/Educational assessment Combined assessment Other assessment Please specify(Required) How can we help?(Required) Feeling really down or depressed Anxiety or constant worrying Relationship problems Grief and loss Low self-esteem or confidence Trauma Life changes or feeling stuck and wanting personal growth Addiction or unhealthy habits Stress (eg. At work or at school) Social struggles Health-related challenges Difficulties related to Autism Difficulties related to ADHD Hearing voices or hallucinations Other Please specify(Required) Would you like to be seen in person or via video?(Required) Video In Person - Jumeirah Lake Towers Flexible - video or in person Morning(8am to 11am) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Lunch (11am to 2pm) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Afternoon(2pm to 5pm) Monday Tuesday Wednesday Thursday Friday Saturday Sunday Evening(5pm to 8pm) Monday Tuesday Wednesday Thursday Friday Saturday Sunday This field is hidden when viewing the formMonday Morning (8am to 11am) Lunch (11am to 2pm) Afternoon (2pm to 5pm) Evening (5pm to 8pm) (8am to 11am)This field is hidden when viewing the formTuesday Morning (8am to 11am) Lunch (11am to 2pm) Afternoon (2pm to 5pm) Evening (5pm to 8pm) This field is hidden when viewing the formWednesday Morning (8am to 11am) Lunch (11am to 2pm) Afternoon (2pm to 5pm) Evening (5pm to 8pm) Do you/the child have a preference for a male or female therapist?(Required) Male Female Don't mind Are you planning on using Pay and Claim or self-funding?(Required) Pay and Claim Self-Funding (From 750 AED)