Please read the following terms carefully. By filling out this application form, you agree to the following terms and know that Chinese in Wales Association (CIWA) has the right of final interpretation.

1. This form is to be used for the provision of counselling for Chinese residents in Wales

2. On receipt of this form, our staff will arrange an initial assessment with client and  refer client to the professional counsellor. The counselling service takes the form of remote connection (video or telephone).

3. We keep the information you provided strictly confidential, and only share it with personnel related to this service, unless it involves legal requirements.

4.By filling in this form you confirm that client has prior knowledge & consents you to make this referral.