Register as a Client

The Couch 

 Physical Address: 40 River Road
Rivonia
2191
Office Phone Number: 011 234 0741
Mobile Phone Number: 071 682 7107
Web: www.thepsychologycouch.com
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

All details are Strictly Confidential

Client Details

Please let us know your name.

Your First Names

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Your Surname

Contact Details

Please Let us Know your Home Phone Number.

Home Telephone Number

Please Let us Know your Cel Phone Number.

Cell Phone Number

Please Let us Know your Work Phone Number.

Work Telephone Number

Please let us know your email address.

Your Email Address This will also be used to register you on our website.

Please supply your ID Number

Your ID Number

Please tell us your Date of Birth

Your Date of Birth

Terms and Conditions

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Head Office

37 Homestead Road,
Corner 12th Avenue
Block F, Homestead Park
Rivonia, Sandton
060 961 7882
Tel: (011) 234 0741

The Couch
Online consultations are now available

Please note that if you are unable to contact us on 011 234 0741 due to the Load shedding, kindly contact us on 060 961 7882

SA COVID