First name:

Last name:

Your organisation / school

Your phone number:

Your email:

I am enquiring as a:

I would like more information about:
Play therapy for a child(ren)Child/parent relationship therapy (filial therapy)

(Leave the following blank if you are enquiring about a group of children)
Child's age:

Child's gender (female / male / intersex / trans / non-binary):

Child's name:

Child's main problem areas:
Attention deficit / hyperactivity disorder Oppositional defiant disorderAdoption or FosteringAggressive or Angry behavioursAnxiety or DepressionAttachment or bonding issuesAutism spectrum disordersBullyingChronic illness or medical anxietyDivorce or SeparationGender varianceGrief or lossSchool or Social difficultiesSelective mutismSelf-esteem & Self-confidenceSexual abuse, physical abuse or neglectSleeping difficultiesToileting issuesTrauma

Additional information or other enquiries:

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