Counselling Booking Form FirstnameLast NameEmployer / OrganisationORG IDEmailWe suggest you use a private email address to receive confidential emails.PhonePlease provide a phone number you can be reached on at your requested appointment time.What age are you?16–2526–3536–4546–5556–6565–7576 or overYou must be 16 years or over to receive services. What's your primary area of concern?Personal/EmotionalRelationshipMental HealthStressAddictionTraumaFamily-RelatedWork-RelatedOtherPlease summarise what you would like to talk about.This is a secure and confidential booking form, seen only by our Case Management Team.Callback DateCallback Time (in current U.K. timezone)If you have a hearing loss or tinitus and require an alternate method of communicating with a counsellor, click here:What is your preferred method of communicating with a counsellor? Standard phone callLive text/chat (WhatsApp or Microsoft Teams)Text phone (BT Relay)Video call in BSLImportant Note re. Video Call in BSL: If you require a video call in BSL we will send you a separate email outlining the details of how to connect with your counsellor. As we rely on a 3rd party to deliver sessions in BSL in some instances your requested session time may not be available. All sessions are typically scheduled within 48 hours of your initial request and will be confirmed via email.