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BOOKING INFORMATION & REFERRAL FORM

Please use the form below for referrals and to enquire about availability for In-Person or Online sessions.

 

Usually we contact you about availability first and then organise a 15-20 minute referral phone call with you. The call is to understand more about you and the ensure the service is suitable for you and for you to find out more about us :) The call is confidential and free of charge

 

Your first full session is chargeable and payment in advance is required to secure the booking if you are self-funding.

 

REFERRAL FORM 

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​A. Please note that Pause Psychology is not a crisis service. We do not have the capacity to provide support for clients experiencing severe levels of distress and suicidal ideation which need immediate assistance. If you require urgent support, please contact your GP, Avon & Wilts Mental Health Trust Crisis line on 0800 953 1919 or Bristol Mental Health crisis line on: 0300 555 0334. You can also get support from The Samaritans 24 hours a day, by phone or email and from Mindline in Somerset 0800 138 1692.

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B.  Before completing this referral form, we need to ensure you understand what happens to the information you provide us.

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  • We process the information provided in this form, along with any other correspondence with you, to enable us to see if I am a suitable Psychologist for you to work with.

  • The information provided in this referral is reviewed by staff from Pause Psychology Bath.

  • If I do not have availability or I am not a suitable Psychologist, we will let you know.

  • In general, we do not operate a waiting list.

  • In rare instances, if we are very concerned by information provided in this form, we may need to pass information on to other health or statutory agencies.

  • We provide more information about how we process data in our GDPR and Data Protection statements, available on request.

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Which therapy format do you prefer?
In-Person Sessions
Online Sessions
Either In-Person or Online

Your Personal Details

Please provide a Brief Summary of the difficulty or problem you would like support for:


We find that 4 or 5 sentences provides us with helpful detail. It is good to include:

  • the nature of the difficulty (e.g. thoughts, feelings, behaviours)

  • any relevant life events

  • the impact of the difficulty on everyday life

Pause Psychology is a private psychological therapy service and fees range between £90 -£130. Please see Sessions information on the website for further detail.

Please indicate how your sessions will be funded:
Please indicate your availability below:

Nick Cudworth View of Bath from Lansdown

simple  -  HELPFUL  -  RESEARCH-BASED  -  ONLINE  -  IN-PERSON  -  EMDR
 

    PAUSE PSYCHOLOGY 2025

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