Request an Appointment

To ensure you receive the best possible care it is important that Dr Bonoldi is able to review your current situation and challenges, as well as your medical history, if relevant.

If you wish to request an appointment with Dr Bonoldi, please complete the form below.

If Dr Bonoldi is able to assist you, she will confirm your request and send you a link to book your first appointment.

Appointments are generally available for new patients and new assessments within two weeks of enquiring.

Name

First Name

Last Name

Contact Email

Contact Phone

(###)

###

####

Date of Birth

YYYY

How would you describe the issue or challenge you're looking to address?

Could you describe a little about your Mental Health history (if any)?

This would typically include any previous engagement with Services (counselling, psychology or psychiatry), any history of self-harm of any form, and anything else you feel relevant.

Are you currently under the care of any other Mental Health Services?

This would include Community Mental Health Teams (CMHT), counsellors, or other related services.

Yes

If you are under the care of another Mental Health team, please list their name/s and service/s below:

Please also include whether the service is NHS or another private provider.

Are you currently taking any medication (both psychiatric, and non-psychiatric)?

If so, could you detail the medication, the dosage, how long you've been taking it and - for psychiatric medication only - when you will run out of your current prescription

Do you have any other physical health concerns at this time, or any ongoing physical health aspects that you manage?

Do you feel that you are at risk; for example of self-harming, being reckless and endangering yourself, or even having thoughts of not wanting to live? If so, could you describe this below.

Please note, if you feel that you might enact any of the above we would strongly suggest that you attend your nearest A&E department where the on-call Liaison Psychiatrist will be very helpful and supportive, and arrange more intensive care.

How will you be funding your consultation/s?

I will be self-funding

Funded via insurer

Where did you hear about Dr Bonoldi's practice?

Is there any additional information you would like to include at this point?

Request an Appointment

Appointments are generally available for new patients and new assessments within two weeks of enquiring.

Thank you for sending your information.