Please give a brief description of the issues you wish to address in counselling and any other information you feel we need to know. If you have ticked other or multiple factors you can tell us more here:
AVAILABILITY AND FEES
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. If your availability has changed by the time we allocate you to a counsellor and you have not informed us, we will not offer you a second appointment and your application will be withdrawn from our waiting list
These measures are in place to help us reduce waiting times and to deliver our services as efficiently as possible.
Kindly tick here to show you have read and understood this statement:
We charge counselling sessions weekly based on your income with the exception of evening sessions which are always £40.
When are you available? Please indicate either yes or no to let us know which half days you will be available to attend your counselling appointment.
**The more options you give us the quicker you will be allocated.**
Morning sessions are 9am, 10am, 11am,12pm
Afternoon sessions are 1pm, 2pm,3pm,4pm
Evening sessions are 5pm, 6pm, 7pm ** £40 regardless of income
Answer either YES or NO to each option.
**Remember to let us know if your availability changes**
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.
Religion or Belief:
Other Religion or Belief:
Other Sexual Orientation: