Holistic Health Solutions, Suite 54, Chatswood Village, 47 Neridah St, Chatswood NSW 2067, 0425 218 022

Self report questionnaire

This is an obligation free service and is only available to sincere requests. Please provide accurate information and complete all questions honestly, otherwise I may not be able to get a clear picture of your present sexual problems and emotional well being.

Also, indicate the best time for me to contact you. This first conversation is not designed to fix your situation, but it gives you the opportunity to briefly speak about your issues and ask me any questions. I may then be able to point out therapeutic directions helpful for your particular situation.















































Thanks for sending the information.

You will hear from me soon. If you have not received a reply within 24 hours please call me on my mobile 0425 218 022 between 9am-5pm (EST-Australia), Mon-Sat.

Please be aware that confidentiality can be compromised when you send email requests due to security limitations on the internet. If you wish to remain anonymous and do not want to fill in the self report form you are welcome to contact me by phone.