Client registration form
Couple counselling
On line or in person for you and a partner (or whoever you identify as significant) to work with a practitioner to explore your relationship with each other. Counselling gives you a space to express your fears and concerns, to ‘hear’ each other and learn new ways to communicate together.
Please complete our form below, this will give us all the information we need to arrange your first appointment. You will be asked to pay an amount for each meeting based upon your household income and using the scale on the form.
Please note that we need both of you to complete a form separately for our GDPR regulations. Failing to both complete a form will hold up your appointments. Please also indicate your partner’s name on your own form so that we can link these.
We understand this is a long form to complete however we will only ask you for this information once. Please call us on 0131 556 1527 if you would like support to complete the form.
Gift Aid
Please consider completing the Gift Aid section at the end of this form. If you’re a UK taxpayer, you can make your counselling contribution worth 25% more, at no extra cost to you. For every £1 you contribute we will receive an extra 25p from HMRC.
Please read our Counselling agreements and contract for clients before submitting your form.
