Your responses to the following questions will help me to understand your specific concerns and needs, so that we can make best use of our time together. I therefore ask that you please take the time to give me as much detail as possible. However, if something does not apply to you, please feel free to leave it blank.

I appreciate that this questionnaire covers sensitive issues. Please be assured that your information will be stored and used confidentially, in accordance with the General Data Protection Regulations (GDPR). Please see my client-practitioner agreement and privacy policy for further information on how your data are stored and used.

Before submitting your completed form, please be sure to tick the boxes at the end of the form to confirm your acceptance and consent. In order for your form to be successfully submitted, these boxes must be ticked and all mandatory form fields completed.

• For detailed information about how I use and store your data, please read my privacy policy