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Form download

Left-click link below to open form in Word (or to save it, if you don’t have a Word plugin for your browser).

Right-click link for download options.


Please print off and complete two forms.

More information graphic 


If you wish to arrange an initial assessment by a therapist, you may optionally download a questionnaire, then complete it and return it to us. This will allow you to tell us in confidence a little about your life and the difficulties you are experiencing, so that we can move forward more quickly with any therapy that may follow.

The form is a Word (.doc) document, and should open in Microsoft Word or a compatible application. You may fill it in on your computer and send it back to us as an email attachment, including your name, postal address and contact telephone numbers to (, or print it out, fill it in by hand, phone us for a confidential code to include on the questionaire and post it to us (click here for contact details).

See panel on right to start download.

If you prefer, we will send you a questionnaire by post. Just telephone the Practice Administrator on 0161 445 2099.


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