The Counselling Space- Registration Form
Please fill in this form before or just after your first session. It is compulsory to complete this form when accessing our services. All information is confidential and your personal details will never be shared unless there is the need to break confidentiality as explained in our services contract and according to GDPR policies. Thank you
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Email *
Full name
Post Code
Do you have children
Clear selection
Contact details (please provide mobile number, email)
GP Details (please provide name, address, tel)
Emergency contact name and contact details
Clear form
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