Self-Referral

If you would like to book a counselling appointment, please complete the form below.

We currently have appointments available with Qualified Counsellors and Counsellors in Training via telephone or Zoom (online video)

ALL SESSIONS ARE COMPLETELY CONFIDENTIAL

We offer daytime, evening and weekend appointments depending on appointment availability.

All appointments are £25 per session

CURRENT OFFER : we can offer concessions

for anyone who is unemployed, furloughed or struggling financially due to Covid19

(please enter COVID19 in the discount code box if you would like to be considered for a concessionary rate)

Alternatively call or text 07895 796857 to book an appointment

Please note we only offer individual counselling appointments.

Full Name

Male

Female

Phone

Town

Reason for seeking therapy?

Have you have been formally assessed of diagnosed with:

Additional information:

Please select if:

You are experiencing suicidal ideations or feelings of wanting to self-harm

You have previously attempted suicide, or have self-harmed

Which day(s) are you available to see your counsellor?

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

What time(s) are you available to see your counsellor?

Morning (9am-noon)

Early Afternoon (noon-3pm)

Late Afternoon (3pm-6pm)

Evening (After 6pm)

Where did you hear about us?

I would like to receive updates for available counselling appointments in the future

Discount code:

07895 796857

Providing Counselling services for clients in;

Cheshire, Derbyshire, Gloucestershire, Herefordshire, Leicestershire, Lincolnshire, Northamptonshire, Nottinghamshire, Oxfordshire, Shropshire, Somerset, Staffordshire, Worcestershire, Warwickshire, West Midlands and Yorkshire.