booking form / Counselling Information page / Counselling

Name *

Preferred method of contact *

Email
Telephone
Text message

Contact Details *

Are you over 18? *

Yes
No

Type of Session *

In-person
Online
Either

What brings you to therapy? (a few words about what you would like support with) *

Have you had therapy before? *

Yes
No

I agree to be contacted regarding my enquiry *

Yes, contact me

I understand how my data will be stored and used in line with the privacy policy and UK GDPR *

Yes
No - take me to the Privacy Statement

This form is not monitored for emergency situations or crises. If you are in crisis, please contact one of the following services, which are available 24 hours a day, 7 days a week.

Telephone numbers -

999 for Emergency Services.

116 123 for Samaritans.

0300 102 2470 for Papyrus Suicide Prevention Charity.

24/7 Textlines -

text the word 'HOPE' to 88247

text the word 'Home' to 741741

text the word 'SHOUT' to 85258