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I’m glad you’re here

YOU’VE TAKEN THE FIRST STEP

This short form helps me understand what’s bringing you to therapy and make sure the support I offer is right for you.

Once I receive your responses I’ll be in touch within one working day with available times and next steps.

What's your full name?

What would you like me to call you?

Email Address

Where are you based? (City and Country)

Are you available for online sessions during UK hours? Are you available for online sessions during UK hours? Yes No

Have you had counselling or therapy before? Have you had counselling or therapy before? Yes No

What's been going on for you lately that's led you to reach out? Share as much or as little as you feel comfortable with

Please select all boxes that apply to you presently or in the past. If none apply, please select 'None' Please select all boxes that apply to you presently or in the past. If none apply, please select 'None' Suicidal Thoughts Suicide Attempt(s) Self Harm Substance Abuse or Addiction None Prefer Not to Say

What drew you to reach out to me?

Where did you hear about me?

My fee is £65 for Initial session and £85-£100 for a 50-minute weekly session; payment is made 1 week in advance. Does this arrangement work for you? My fee is £65 for Initial session and £85-£100 for a 50-minute weekly session; payment is made 1 week in advance. Does this arrangement work for you? Yes, this works for me! I have a question about this

Please share all your availability during the following times (UK / GMT) Monday - Thursday, 8am - 3:30pm Limited evening slots are also available - please indicate if evenings work better for you

Anything else you would like to share?

GDPR Consent GDPR Consent I consent to my information being collected & stored to process this enquiry inline with the Privacy Policy

Ariana Pedzikowska | BACP Accredited Counsellor & Trauma Therapist | London

Trauma-informed therapy specialising in people-pleasing and childhood trauma. Working with adults who carry too much responsibility for other people, struggle to set boundaries, or find it hard to prioritise themselves. Online therapy across London, Manchester, Bristol, Leeds and Edinburgh.