Your Mental Wellbeing

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Let's See If I'm the Right Fit for You

Completing this form is the first step in exploring whether my service is the right fit for your needs. I'll review your enquiry and get back to you as soon as possible.

Already had your first consultation?

This form is for new patients. If Dr Klimowicz has seen you before, book a 30-minute follow-up instead — it's a much shorter form.

Book a follow-up

Before we continue with the enquiry form, are you currently feeling overwhelmed by intense anxiety or experiencing distressing thoughts, such as self-harm or suicidal feelings?

Personal Information

GP Details

I am currently well but have suffered in the past:

Preconception Concerns

Emotional Wellbeing

Medication & Treatment Concerns

Lifestyle & Wellbeing

Family History & Genetic Concerns

Hormonal & Biological Factors

Social & Environmental Concerns

Terms & Conditions

Please read the following before submitting your enquiry.

Initial consultations and follow-up appointments can be cancelled or rescheduled with a minimum of 72 hours' notice. If you cancel or do not attend the initial appointment or follow-up appointment for any reason without at least 72 hours' notice, the full fee will be incurred. All amounts paid in respect of consultant fees are non-refundable and non-transferable unless sessions are cancelled outside the cancellation period.

Any additional services requested by the client (or required due to safeguarding), such as liaison with external parties, may incur additional costs. These costs are composed on a case-by-case basis, based on the hourly rate of the involved clinician. Please note that, depending on your GP's requirements, there may be a £100 fee for completing a Shared Care Agreement (SCA) to facilitate the transfer of care for prescribed medications.

At Your Mental Wellbeing clinic, we take your privacy seriously and your trust is important to us. By booking your consultation, you consent to Your Mental Wellbeing Ltd storing and processing your information in accordance with the GDPR and Data Protection Act 2018.

Please answer the safety question above before continuing.