Send your Toilet Anxiety Assessment results

Thank you for taking the Toilet Anxiety Assessment. This page lets you send your results to us securely so we can review them. It takes less than a minute.

About the “Sessions so far” question

Please tell us how many sessions you have had, if any. An estimate is fine. It helps us track your progress and improve our approach and techniques.

What happens next

We use your Toilet Anxiety Assessment results to improve the therapy we offer you. Your answers help us understand what matters most right now, so we can tailor your plan and track change over time in a simple, meaningful way.

We also use an anonymised version of this information in our ongoing research into toilet anxiety treatments. This helps us refine what works, compare approaches, and improve outcomes for all our clients. Nothing that identifies you is included in this research and we never sell data.

Privacy and consent

If you would prefer not to contribute anonymised data to our research, tell us in the form and we will exclude your assessment.

The Surrey Institute of Clinical Hypnotherapy

274 London Road
Wallington
Surrey
SM6 7DJ
United Kingdom