Client Referral Form

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 and under 18s will attract a higher fee.

Sessions are ‘payable via bank transfer’ 48 hours prior to your appointment and in-line with our cancellation policy.

Cancellation policy is 48 hours notice - if outside of this then the session fee is still payable.