Thank you - Orchestrate Healthcare

Begin your journey to mental wellbeing

Seeking mental health support can be daunting, but we’re here to make it as simple and reassuring as possible.
Give us just 2 minutes of your time to help us begin to understand how we could help.

Who are you seeking mental health support for?

"*" indicates required fields

Step 1 of 15

Are you 18 years old or above?*

Yes

What is your name?*

First name Surname

Hi there, we'd love to understand how we can support you

By sharing your contact details, we can ensure that if you need to pause here, we're still able to provide information and guidance to help you take the next step whenever you're ready.

Email address*

Phone number (optional)

Consent*

I agree to the Privacy, Confidentiality and Data Protection Policies.*

Do you live in London, UK?*

Yes

No, but within 5 miles

We offer remote mental health support worldwide.

Please note that our in-person services are only available in London. If in-person care is essential, you’ll need to make your own arrangements to be in London.

Are you open to receiving support online, or able to attend sessions in-person in London?*

Yes I’m happy with online support or I can make my own arrangements to be in London.

I’m not sure yet I’d like to decide later.

No I need in-person care but cannot travel to London.

What brings you to seek our support at this time?*

Please select all that apply.

Acute Stress Disorder

Adult ADHD

Anxiety

Atypical Depression

Bipolar

Burnout

Clinical Trial

Depression

Eating Disorder

Major Depressive Disorder

Obsessive-Compulsive Disorder (OCD)

Persistent Depressive Disorder

Post-Traumatic Stress Disorder (PTSD)

Postpartum Depression

Premenstrual Dysphoric Disorder

Psychotic Depression

Seasonal Affective Disorder

Other (please specify)

You selected 'Other' - please specify below

We're sorry to hear that you're feeling this way 1, but we're glad you're here. You're not alone, and we can help.

Please tell us, have you ever received an official mental health diagnosis?

Yes

How would you rate the impact of these concerns on your daily life?*

MILD. I'm managing day-to-day, but certain thoughts or emotions occasionally feel overwhelming or difficult to navigate.

MODERATE. My mental health is affecting multiple areas of my life, such as work, relationships, or daily routines, and I'm finding it harder to cope.

SEVERE. My struggles feel overwhelming most of the time, significantly impacting my ability to function. I feel stuck or unsure of how to move forward.

Over the past six months, have you experienced distressing thoughts, including thoughts of self-harm or suicide?*

No, not at all

Yes, occasionally

Yes, frequently

We're here to help you in whatever way you need.

How soon do you feel you need support?*

I'm happy to wait - I can begin when availability allows.

Getting support in the near future would be helpful.

I need help as soon as possible - I'm looking for urgent support.

We believe in the power of truly personalised care

Every individual's journey is unique, and we take the time to understand your needs, preferences, and goals to ensure the best possible support.

Would you like to provide any additional information?

Yes

If you’d like to share anything about your mental wellbeing, past experiences, concerns, or what you’re looking for in support, you’re welcome to do so below (optional).

Orchestrate Health is a self-funded service

Have you previously paid privately for mental health treatment or support?

Yes

Just so you’re aware, our initial assessments start from £795 and are self-funded. Treatment options are also self-funded and not covered by the NHS or private medical insurance.

Are you happy to proceed?*

Yes, let's proceed

No, let's not proceed

Who will be responsible for covering the cost of our services?*

Myself

Someone else

The person responsible for payment is my…*

You selected 'Other' - Please specify below

Please provide their name and contact details*

Fullname (first name and surname) Email or Phone Number

Thank you 1. We appreciate you taking the time to share this information with us.

We're committed to mental health awareness and occasionally share relevant tips, stories and information.

Would you like to receive occasional updates?*

Yes

No, thanks

"*" indicates required fields

Step 1 of 20

Are you 18 years old or above?*

Yes

What is your name?*

First name Surname

Please tell us your name. We’ll ask for the name of the person you’re completing this form for later.

Hi there. Please tell us about the person you are filling this form for.

Is the person you’re seeking support for 18 years old or over?*

Yes

No, they are under 18.

The person I'm seeking mental health support for is my...*

Other family member*

Other (please specify)*

e.g. Step-brother

What is their name?*

First name Surname

Patient's awareness and involvement

We understand that starting this process can be a sensitive step. While it's not essential that they know at this stage, it's important to keep in mind that they will need to engage with their journey to recovery.

We're here to support you in finding the right approach when the time comes.

Has this person been made aware that you're exploring our services on their behalf?*

Yes

Not yet

Consent to share Patient's information

You're welcome to gather information before speaking with them, and permission isn't required at this stage.

However, for the process to move forward, they will need to be involved. If you'd like any guidance on how to approach this conversation, we can help.

Do you have this person permission to provide their information in this form?*

Yes

Not yet

We'd love to understand how we can help you and the person you're seeking support for

By sharing your contact details, we can ensure that if you need to pause here, we're still able to provide information and guidance to help you take the next step whenever you're ready.

Email address*

Phone number (optional)

Consent*

I agree to the Privacy, Confidentiality and Data Protection Policies.*

Does the person you're seeking support for live in London, UK?*

Yes

No, but within 5 miles

We offer remote mental health support worldwide.

Please note that our in-person services are only available in London. If in-person care is essential, the person you're seeking support for will need to make arrangements to be in London.

Is the person you're seeking support for open to receiving support remotely or able to make arrangements to be in London?*

Yes, happy with remote support or can make arrangements to be in London.

I’m not sure yet, I’d like to decide later.

No, in-person care needed but cannot travel to London.

What challenges or difficulties has the person you're seeking support for been facing that you feel our services could help with?*

Please select all that apply.

Acute Stress Disorder

Adult ADHD

Anxiety

Atypical Depression

Bipolar

Burnout

Clinical Trial

Depression

Eating Disorder

Major Depressive Disorder

OCD

Persistent Depressive Disorder

Post-Traumatic Stress Disorder

Postpartum Depression

Premenstrual Dysphoric Disorder

Psychotic Depression

Seasonal Affective Disorder

Other (please specify)

You selected 'Other' - please specify below*

We're sorry to hear that they is feeling this way, but it is important to remember that they're not alone, and we're here to help.

Please tell us, has the person you're seeking support for ever received an official mental health diagnosis?*

Yes

I don't know

How would you rate the impact of these concerns on their daily life?*

MILD. They're managing day-to-day, but certain thoughts, actions or emotions occasionally feel overwhelming or difficult to navigate.

MODERATE. Their mental health is affecting multiple areas of life, such as work, relationships, or daily routines, and they're finding it harder to cope.

SEVERE. Their struggles feel overwhelming most of the time, significantly impacting their ability to function.

Over the past six months, has the person you're seeking support for experienced distressing thoughts, including thoughts of self-harm or suicide?*

No, not at all

Yes, occasionally

Yes, frequently

I don't know

We're here to help you and the person you're seeking support for in whatever way you need.

How soon does this person need support?*

Happy to wait - begin when availability allows.

Getting support in the near future would be helpful.

Help needed as soon as possible - looking for urgent support.

We believe in the power of truly personalised care

Every individual's journey is unique, and we take the time to understand each persons needs, preferences, and goals to ensure the best possible support.

Would you like to provide any additional information?

Yes

If you’d like to share anything about the person's mental wellbeing, past experiences, concerns, or what you’re looking for in support, you’re welcome to do so below (optional).

Orchestrate Health is a self-funded service

Have you or the person you're seeking support for previously paid privately for mental health treatment or support?*

Yes

I don't know

Just so you’re aware, our initial assessments start from £795 and are self-funded. Treatment options are also self-funded and not covered by the NHS or private medical insurance.

Are you happy to proceed?*

Yes, let's proceed

No, let's not proceed

Who will be responsible for covering the cost of our services?*

Myself

The person I'm seeking support for (Patient)

Someone else

Since someone else will be covering the cost of our services, we need to know how they're connected to the person you're seeking support for.

The person that will be paying is the patients...*

You selected 'Other' - Please specify below*

Please provide their name and contact details*

Fullname (first name and surname) Email or Phone Number

We appreciate you taking the time to share this information with us.

We're committed to mental health awareness and occasionally share relevant tips, stories and information.

Would you like to receive occasional updates?*

Yes

No, thanks

Head Office

Thank You!

We’ve received your message – and we’re thrilled to connect with you!

Hi there, we'd love to understand how we can support you

We offer remote mental health support worldwide.

We believe in the power of truly personalised care

Orchestrate Health is a self-funded service

Thank you 1. We appreciate you taking the time to share this information with us.

Hi there. Please tell us about the person you are filling this form for.

Patient's awareness and involvement

Consent to share Patient's information

We'd love to understand how we can help you and the person you're seeking support for

We offer remote mental health support worldwide.

We believe in the power of truly personalised care

Orchestrate Health is a self-funded service

We appreciate you taking the time to share this information with us.