Initial Enquiry Form | Mind Nav Therapy

Personal Details

Please provide your contact information.

First Name *

Please enter your first name.

Last Name *

Please enter your last name.

Date of Birth *

Please enter your date of birth.

Gender Identity

Email Address *

Please enter a valid email address.

Phone Number *

Please enter your phone number.

Home Address

How did you hear about Mind Nav Therapy?

Step 1 of 2

Enquiry Details

Tell us what has brought you to reach out.

Main reasons for seeking therapy *

Please describe your main concerns.

How long have you been experiencing these difficulties?

What are your goals for therapy?

What has triggered or worsened your difficulties recently? (if applicable)

Appointment Availability

Please indicate the days and times that generally suit you best.

Preferred days *

Please select at least one preferred day.

Preferred times

Preferred session format

🖥 Online (video)

🏢 In-person

No preference

Any scheduling constraints or notes about your availability?

Additional Information & Questions

Is there anything else you would like Magdalena to know, or any questions you would like to ask?

Additional information

Questions for your therapist

🌿

Thank you for your enquiry

Your enquiry has been received. Magdalena McKee will review it and be in touch within 1–2 working days to discuss next steps.

Mind Nav Therapy

Magdalena McKee
📧 [email protected]
🌐 www.mindnavtherapy.com
📍 80 Anticur Road, Dunloy, Ballymena BT44 9DW

If you need support while waiting, you can contact your GP or:
Samaritans: 116 123 (free, 24/7)

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Personal Details

Enquiry Details

Appointment Availability

Additional Information & Questions

🔒 Data Protection & Consent

Thank you for your enquiry