Information request: Diagnosis & Beyond

Name (required)

Address (required)

Postcode (required)

Your Email (required)

Your phone number (required)

Are you: (please select)

If you are the person who is going to have the diagnostic formulation, please complete the following questions (1 to 4)

1. Date of birth

2. Diagnoses you have been given

3. Why you want to have an independent diagnostic formulation

4. Where would you like to meet us? We recommend somewhere that you feel safe to have a private conversation, without interruptions. We can arrange this at our base near Uxbridge if that is most convenient for you.

If you are applying on behalf of somebody else, please answer these questions (numbered 5 to 8)

5. How are you related to the person to whom this applies? (select from the box below)

6. Are you applying with their knowledge and consent? (tick box) YesNo

7. Why do you feel they need this service?

8. Why do you think they are unable to complete this application themselves?

9. General message or query (type in the box below)

We aim to answer all queries with a phone call or email within a week.

In that initial conversation, we will decide with you then whether this process is likely to be helpful, set a date for it to happen, and discuss our fees.

Please remember that this is a collaborative process to co-construct a diagnostic formulation: it cannot be done without full cooperation, and is not suitable for medico-legal reports or other adversarial adjudications.