Couple counselling referral

Please complete the form below if you wish to arrange a Welcome Meeting for you and a partner. We’ll reach out to you by phone or email to arrange a specific date. Welcome Meetings cost £29 for a session and you will have an opportunity to discuss your contribution for regular appointments at the meeting. If you are looking to attend on your own you can complete an Individual Referral.

Name *
Name
Address
Address
I am able to receive contact by:
We will use these details to contact you about available appointments and will not share any clinical or personal data through them. Typically we will use your contact details only to confirm appointments and they will not be shared with your counsellor. Details will be stored for 7 years in accordance with GDPR.
Do you have any disability or access requirements? *
Are both partners aware of this enquiry *
Has domestic abuse ever been an issue? *
Would you feel safe to discuss this together in counselling? *
Please outline your availability for a Welcome Meeting *
We will contact you to arrange a specific time and date.
If you like you can indicate any preference below. You can find details of locations and opening times by clicking here.
Are both partners planning to attend a Welcome Meeting together? *
If not we can arrange an individual Welcome Meeting for you both separately, and make an arrangement from there.