Reviewing the Terms of Service may not be the most exciting task, but it’s important to take the time to do so. These terms provide essential information about your consultations and the responsibilities we have towards each other.

These terms are in place so you can make the most out of your therapy sessions. By embarking on this therapeutic journey, you implicitly agree to abide by the Terms of Service.

If you have any questions or encounter difficulties when filling out the online consent and registration forms, please don’t hesitate to contact me at [email protected].

I’m here to help and want to ensure you feel comfortable and fully informed throughout the therapy process.

Current step:Terms of Service
About you
Emergency Contact
GP Details
Health Insurance
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Reputation

Please complete your registration below. After you press the submit button, please wait for confirmation that your information has been successfully sent.

If you are completing this form on behalf of someone else, please fill in the contact details of the person who will be receiving the service.

Consent Form

Please write your first name
Please write your middle name(s)
Please write your last name
If you're completing this form on behalf of someone else, please write your full name here

Registration Form

About You

Please select your date of birth
Please write your mobile phone number
Please write your street number and address
Please write your city
Please write your postcode

Your Emergency Contact

Your emergency contact is someone Dr Nick can call to ensure your safety
Please select how you are related to your emergency contact
Please write your emergency contact's mobile number

Your GP Details

Please write the name of your GP practice
Please write your GP's phone number
Please add your NHS number
Please write your GP's street number and address
Please write your GP's city
Please write your GP's postcode

Health Insurance (insured clients only)

Is your Private Medical Insurance Funding your Treatment? *
Please write the name of your insurance provider
Please write your pre-authorisation code
Please write the name of your policy
If your policy has an excess please write the excess amount here
Please write the number of sessions your insurance provider has authorised

Share files with Dr Nick

Please drag and drop files in this area, such as professional assessments or reports related to your mental health. A total limit of 20MB applies.

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