Psychodynamic Counselling Application
FOR APPLICANTS AGE Under 18, a parent must submit this form.

Individual Counselling
15+ Counselling for people suffering with grief & loss, depression, anxiety, PTSD, OCD, substance abuse & addiction. (alcohol, drugs, gambling & gaming disorder)
£15 one hour Session

Family/ Couples Therapy
One hour weekly session to work through feelings in family conflicts & build healthy relationships with each other.
£35 one & 15 minutes session (max family of 6)

Counselling helps build confidence, self esteem, alter undesirable habits, thinking & behaviours and improves relationships.

Conducted by a trained Independent Psychodynamic Counsellor:
CFPS Child & Adolescent Counselling (University of Cambridge)
Level 3, Child & Adolescent Counselling in Schools (PLACE2BE)
Diploma in Psychodynamic Counselling (CCF)
PG Cert, PG DIP, Neuroscience of Mental Health (Kings College London)


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Email *
Full Name *
Date of Birth 
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DD
/
YYYY
Contact Number *
Payment details: 
Payment is due when you arrive for your first session.
Bank Name: Al-Rayan Bank, Alhuda Welfare Foundation UK Account Number : 01346901 
Sort Code : 30-00-83. 
Reference: Please quote your reference as 'Counselling'. 
Please ensure correct reference is entered and you retain receipt as proof of payment.
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