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Thank you for your interest in receiving counselling with us, before taking you to the application we would like to clarify a few points, kindly tick each statement to indicate you have read and understood it.
Please note that if you are accessing counselling to address adoption issues, eating disorders, substance misuse or bereavement we would advise you to contact other specialist counselling services.
We will now take you to the application; kindly complete all sections as thoroughly as you can.
* Due to increased demands on our service, we are currently only accepting applications from the Boroughs of City and Hackney, Haringey and Tower-Hamlets
To select multiple options:For Windows: Hold down the control (ctrl)+ select For Mac: Hold down the command button
Post Traumatic Stress Disorder:
Multiple Factors (please explain below):
Other (please explain below):
Please note that it is important to state the days and times you are able to commit to regular sessions.
Once an appointment has been confirmed, we are unable to reschedule this without returning your application to the waiting list. This includes being reallocated from a daytime to an evening appointment
Your counselling will be at the same day and time each week. If your availability changes whilst you are waiting for an appointment, you must contact the centre to inform us.
These measures are in place to help us reduce waiting times and to deliver our services as efficiently as possible.
We charge counselling sessions weekly on a sliding scale based on your employment status for the exception of evening sessions which are always £25.
To select multiple options:For Windows: Hold down the control (ctrl)+ select For Mac: Hold down the command button+select
How did you hear about us?:
Optional: you do not need to fill in the following questions if you do not wish to, however we appreciate if you do, as it helps us to ensure that our services reach the widest possible audiences and that they are available to sections of the public that may be underrepresented. This part of the application will be kept separately and anonymously for monitoring purposes only.
Thank you for completing this application, we use all information in accordance with the data protection act.
Kindly type your name below to consent to your information being processed by us.
Please click here to access our policy about how your personal details will be handled.
You can withdraw your application at any time by emailing: firstname.lastname@example.org