• In case you are interested in starting individual or couples therapy with me, please take a few minutes to fill out this intake form. Therapy is a collaborative process between client and therapist. For the therapist to be able to offer a secure environment, the client and the therapist have to have the same goals. Before booking a first session with me, I would like to have more information about you. For this reason, if you are interested in starting a therapy with me, I ask you to fill out the intake form below. I will review your information and answer you within one week to book a phone call. The first phone call (free of charge) will consist of a 15-minute conversation where we can both ask some clarifications.

    In case you don't feel comfortable submitting the form online, please add more information in the previous information text block.

    Alternatively, you can use the 15-minute phone call to complete your Intake Form over the phone with me.

  • As the client-therapist relationship is highly personal, it is possible that the intake reveals that I am not the best therapist to help you. In that case, I will do my best to refer you to a better suited therapist.
    If for some reason I am away and unable to schedule our phone call within a week you will receive an automatic reply email notifying the period in which I will be absent. You can then count that I should take one week from that date of my return to revise your intake form and contact you.
  • Personal information

  • Contact information

  • Clinical information

  • My availability is from Monday to Friday from 9:00 until 18:00 (Central European Time)

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