Initial Assessment Form
Information required to begin sessions

Data required for Initial Assessment Session

First & last name*

Email*

Emergency Contact Name*

Emergency Contact Number*

GP Name & Surgery*

Do you identify as neurodivergent?

Yes

No

Have you received a diagnosis of any syndrome, difference or condition by a medical professional (or other)?*

If you woke up tomorrow and the problems had disappeared, what would be different?

Please complete and submit this PHQ9 form for the next steps in sessions

Contact

First name*

Last name*

Email*

Repeat Email*

Phone *

Your message*

Commerce House

Carlton Boulevard

Lincoln LN2 4WJ

Sessions require payment on booking

Sessions with 7 Swans Therapy Lincs are accessible face to face or via video-link using the Google Meet platform.

For video sessions you need a good internet connection, audio and camera, set in a place you won't be interrupted or overheard.

For information about data retention please visit Terms & Conditions and the privacy policy.

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