Please fill in our Sign-up form in order to use our services. Submitting the form means you have agreed to our Terms & Conditions, and once your information is approved you will receive an email and can book and use any of our online services.

Fields with an * are required to be filled-in.

Name *

First Name

Last Name

Date of Birth *

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Gender

We request this information as gender may be hormonally relevant if medication is prescribed, or for group allocation.

Male

Female

Non-Binary

Other

Please state other gender if you so wish?

Email *

Phone *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Who recommended or referred you to Freo?*

Medical Doctor eg. GP or Other Specialist

Other health professional eg. Counsellor, Psychologist, social Worker

Friend

Word of Mouth

Online through Social Media

Court

Family Member

No One - I was loking for a suitable therapy place

Which Therapy & Counselling option are you most interested in accessing, if any? *

What social activities would you like to participate in or enjoy?*

Yoga

Meditation

Mindfulness

Personal Training

Stretching

Breathing Exercises

Brain Gym

Live Music Evenings

Online Remote Travel Tours

Art Therapy Sessions

Music Therapy

Singing Lessons

Sax Sessions

Etiquette Classes for Kids

Etiquette Classes for Teens

Etiquette Classes for Adults

Healthy Nutrition Classes

African Cooking Classes

Reiki

NLP - Lightening Process

Parents Forum

Couples Forum

Brief summary of what you would like help with please?*

Can't be blank

Are you acutely unwell, very depressed, suicidal or experiencing hallucinations? If so please describe symptoms below. If not please write N/A, thanks*

How would you like us to contact you to follow up?*

Text

Please don't contact me

If you want us to contact you, please what time and day is best?*

Discount / Referral Code

If you have a voucher or referral code that led you here, let us know so we can apply your discount!