Counselling Registration Form

Please complete this form, all information provided is considered highly confidential with procedures in place protecting and respecting your privacy.
Please note: When processing your form, we always use codes and not your name.
Please note the counselling service is currently in its pilot phase and offering low cost therapy session at £20 per session. For further information, please contact

Please note that we can only provide our counselling service to UK Residents only.

Emergency Contact Details