Family Therapy Enquiry

Please complete the form below

This form is regarding therapy involving separated families, whether court ordered or by agreement. If you are seeking support for an intact family, couples therapy, individual adult of child therapy, or any other issue, please call us on 02 9221 1111 or email reception@therelationspace.com.au with with your enquiry.

Your name

First Name

Last Name

Your email address

Your phone number

Do you have Court Orders for this therapy?

Are there currently court proceedings underway?

Yes

No

Name of Ex-partner

Number of children

Age of each child

Separate with commas

Any other information you would like to provide