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Adult Counselling Referral Form

(For client's ages 6-17 Please complete Child Referral form at the bottom of the page)

Online & Telephone counselling appointments available within 24 hours

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Appointments are charged at

£40 per session

Gender Required
Please select if...
Which day(s) are you available? Required
Which time(s) are you available? Required
Please confirm if you have a preference on the gender of your counsellor
Please confirm your preferred session method(s) Required

Online & Telephone counselling appointments available within 24 hours

​

Appointments are charged at

£40 per session

Child Counselling Referral Form
Ages 6-17
(For 18+ Please complete above Adult Referral form)

Online & Telephone counselling appointments available within 24 hours

​

Appointments are charged at

£40 per session

Gender Required
Please select if...
Which day(s) are you available? Required
Which time(s) are you available? Required
Please confirm if you have a preference on the gender of your counsellor
Please confirm your preferred session method(s) Required

Online & Telephone counselling appointments available within 24 hours

​

Appointments are charged at

£40 per session

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