Before booking a first appointment please fill the form, it will help me understand better your request.
Don’t worry, there are no right or wrong answers, everything will be helpful for me to start planning what kind of service will be tailored for you.
After our first meeting, we will decide together the rules of the psychological journey we will eventually begin.

Questions indicated with an * are required.

Name and Surname

Nome

Cognome

Gender

Age

City

Profession

(please state your job or occupation)

Telephone

(your phone number is required to establish a first contact)

E-mail

Where

(choose between a face-to-face therapy in my study or a psychological support online)

Family History

(write briefly if you live with someone or alone)

What doesn't satisfy you

(write, using your own words, the reason why you're asking for help)

Previous therapies

(write if you had any psychotherapies before, and how much did they last)

Other

(inserisci qui eventuali domande o preferenze aggiuntive, ad esempio se preferiresti incontri settimanali o bisettimanali, disponibilità di orari, etc.)