Referral for Counselling
We provide individual counselling for anyone over the age of 18. Please complete all relevant sections of this form so that we can process your referral and place you on our waiting list. We are limited by insurance to provide counselling within the UK, and therefore cannot provide counselling to anyone located outside the UK even on a temporary basis. Our service is funded to provide counselling to people within the Aberdeen area only.
Cairns Counselling is not an emergency service and cannot provide an urgent response to those in a crisis. If you do not feel safe, or are under threat, or need to talk to someone urgently, there are other services which may be able to help. A list of alternative support can be found by clicking the undernoted link.
I confirm my referral is not for crisis support
I do not wish to proceed with a referral at this time
Date of Birth
Prefer not to say
Prefer not to define
What is your ethnic group, please choose the option that best describes your ethnic group or background
Mixed or Multiple ethnic groups
Asian, Asian Scottish, or Asian British
African, Scottish African, British African
Caribbean or Black
Other ethnic group
If you do not have an email, please type in email@example.com
Please enter a valid phone number.
Are you currently receiving counselling elsewhere?
How did you hear about us?
From my GP
From another health professional
From a friend or family member
From another counselling service
From another service
Please select all relevant items from the following list to tell us know a bit more about you and what brings you to counselling.
Problems from childhood
Bereavement or loss
I have difficulty regulating my emotions
Issues in employment
Physical health problems
I don't feel like myself
I take prescribed medication for my mental health
OCD or phobias
Affected by another's substance misuse
Post natal depression
Racial abuse or discrimination
Low self esteem or confidence
Recent suicide attempt
We have a Faster Flexible Service which is provided at a cost of £45 for each session, payable in advance. The payments we receive from these sessions, helps fund us to provide the majority of our counselling by donation for those unable to pay. Please confirm whether or not you wish to access this service:-
Yes - I wish to access the Faster Flexible Service - and understand that there is a fixed fee of £45 per session (shorter wait)
No - I wish to use the open access service - and understand that the donation I make goes towards running costs and will help the service to continue (longer wait)
We rely upon regular donations to provide your counselling. We would be grateful if you can consider making a regular contribution based on what your resources will allow. The following information will help provide a guide for your self-selected donation commitment. Please be reassured that you will have the opportunity to discuss this prior to counselling beginning. The amount and frequency of your donation will remain a choice.
Limited income, where you have to be careful to be able to pay for the basics you need. - £3 to £10 per session
Moderate income, where you can pay for everything you need but there is not much left over for luxuries. - £10 to £20 per session
Comfortable income, where you can easily pay for everything you need and have enough for a few luxuries. - £20 to £40 per session
I am unsure
Is there anything else you think we should know?
Would you like to be kept up to date on Cairns Counselling?
Please verify that you are human
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