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Welcome to the Midlands Family Therapy Group website, please feel free to e-mail us with
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Assessment Form


We believe that whatever the problem, it affects the whole family. For this reason we invite you as a family to the assessment. However we are aware there may be many reasons for choosing to bring certain family members and not others. Your decision will be respected. The assessment will last about 1 hour and a half, the time of the appointment and venue can be negotiated with you. In order that we can make the best use of time, a form is provided, that will ask for basic but important information about your family. If you do fill this in, it would be helpful if we could receive it one or two days before your appointment. We suggest you find some time to sit together as a family to fill this in. If you would like a copy of the form for each family member, please let us know

Name



Telephone Number



Email address:



Address:



In your view, what are the main difficulties?



How long have you been experiencing these problems?



Who in the family is most affected by the problems?



How are you managing to get on with your lives despite the presence of these difficulties?



What kind of help do you think you need?



Additional Comments:


Please enter the code that appears in the image into the text box provided below and click send.