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Contact - counselling enquiries
Please use this form if you are inquiring about sessions for yourself. If you are inquiring on behalf of someone else, please return to the website and complete the referral form. 
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Your name (the name you wish to go by, first and last) *
Pronouns
Your age *
Email address *
Contact phone number (only used for texting, in case I end up in your spam filter) 
Please give a brief summary of your situation and what you would like to talk about in therapy (there is no need to go into detail if you don't want to at this point). You can also use this area to tell me anything I might need to know about your access needs.  *
Please indicate which services you are interested in (you can pick more than one) *
Required
How did you hear about Off Beat Therapy?
I understand that my details will only be used for legitimate correspondence in relation to counselling. I have read the privacy policy available at https://www.offbeattherapy.com/privacy-policy *
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