Counselling Request Form
PCCS offer free, professional counselling to anyone suffering due to pregnancy or early parenthood. Issues we regularly support people with include pre-conception counselling, pregnancy support, infertility, stillbirth, miscarriage and termination.

If you want more information about the 2 services we offer please visit our website www.counsellingandcare.co.uk

This form can be used to sign up for our long-term and fast-track services.

Please complete this form as honestly as possible. If you don't feel comfortable providing information online you can also call our office on 0131 557 2060.

For our long-term service we will contact you within 7 days in order to set up your initial assessment.

For our fast-track service we will contact you on our next working day to set up your first appointment.

Please be aware that all our counselling is offered from our office on Haddington Place, Edinburgh.

Email address *
Your name *
Your answer
Telephone number *
Your answer
Email *
Your answer
Preferred method of contact *
Are you interested in our long-term counselling or fast-track service? *
Please provide your rough availability for your initial assessment *
Morning
Afternoon
Monday
Tuesday
Wednesday
Friday
Please include a brief description of your referring issue, it really helps us when setting up your appointment *
Your answer
Do you have any other questions or concerns that you would like to raise with us at this time?
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service