Please fill out the form below. For any fields that are not applicable please enter N/A.
When giving income you must include any benefits you are in receipt of.
Any session prices quoted below are purely a guide as some complex counselling needs may attract a higher fee.
If you require the couple referral form then please click on the button below.
Client Couples Referral Form
Personal information which you supply to us may be used in a number of ways, for example:
For further information on how your information is used, how we maintain the security of your information, and your rights to access information we hold on you, please visit https://www.counsellorstogether.co.uk/terms