Private assessment referral form

Please Provide a Brief Summary of the Difficulty for Which You Would Like Support.

We find about 4-5 sentences provides us with enough detail to match you with the right therapist.
It's helpful to include details such as:

• the nature of the difficulty (eg thoughts, feelings, behaviours)
• any relevant life events
• the impact of the difficulty on everyday life.

Some of the therapists to whom we refer work use creative mediums alongside talking therapy (eg. Play Therapy for children / adolescents; Music Therapy for children / adolescents & adults). If you would rather not be referred to one of these therapists, just let us know in the box below.

Your appointment preferences

When matching your referral with an affiliated therapist, we will do our best to meet your preferences. However, please be aware that increased preferences can significantly increase wait times e.g. fewer affiliates offer after work appointments. For certain difficulties, only one affiliated therapist may be suitable, limiting options to their clinic times.

Please indicate your preferences for appointment location

Bristol - North, South, Central Bath Bristol - North, South, Central Bath

Please indicate your preferences for the therapist's gender:

Either Male Female

Please indicate your availability to attend appointments (please select all possible options)There are currently very few affiliates offering evening or Saturday appointments.

(limited availability)

Fee Agreement

I understand that BrPS is a referral service for private psychological assessment & therapy and all therapists charge fees for all services (approx. £80-95 per hour).

Funding

Please indicate how you will be funding.
Please note, unfortunately only a minority of affiliates are registered with (only certain) providers - please email us if you would like more information.

Self-Funding
Insurance / other