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Question 1/8
What is your age?*
Question 2/8
Where are you currently located?*
City/Town*
Country*
Zip/Post code
Question 3/8
What service are you seeking?*
Assessment
Therapy
Supervision (For mental health professionals only)
I don't know
Question 4/8
What session format do you prefer?*
In-person
Online
Phone
No preference
Question 5/8
Briefly describe your concerns and share any preferences for your ideal professional (e.g., specialization, gender, availability)*
File Upload (Optional)
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Question 6/8
What is your preferred method of payment?*
Self-funded
Private health insurance
Other
Who is the health insurance provider?*
AXA
BUPA
AVIVA
CIGNA
VITALITY
WPA
What is your budget?*
Limited < £100
Mid-range £120 - £150
Unlimited > £150
Question 7/8
How did you hear about My Triage Network?*
Word of mouth
Google
Instagram
Facebook
LinkedIn
Thank you for answering the questions!
Question 8/8
How can I get in touch with you?*
Name*
Email*
Phone number
I agree with the Terms & Conditions.
Great! Please submit your answers, and I’ll be in touch soon to discuss your options.
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