Self-Referral - Verdure Psychology

Request a free, no-obligation consultation call

We’ll aim to get back to you via email within 48 hours of you completing this form. If we believe we can help, we’ll arrange a mutually-convenient time for us to speak to discuss your needs in more depth.

Please ensure you’ve read the information on the Getting Started page so you understand our fees and how we work.

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Your name

Email address

Confirm Email

Telephone number

How can we help?

Please provide an overview of the difficulties you're experiencing that you hope Verdure Psychology can help with (the more information you provide, the easier it will be for us to assess our ability to help).

Payment of Fees

Before submitting the referral please ensure you understand the cost of assessment and therapy with Verdure Psychology.

Please confirm the following:

I am 16 years of age (or over) and I consent to this enquiry being processed in accordance with Verdure Psychology's Privacy Policy.
I confirm I am not experiencing significant risk issues, such as suicidal ideation (if you're submitting this form on behalf of your child, please tick this box to confirm they are not in need of urgent crisis support, to the best of your knowledge).