Please complete this form to book a consultation
This form is confidential and will not be shared. A response will come by email, and can generally be expected within 24 hours.
Name
*
First Name
Last Name
Email
*
example@example.com
I am looking to attend counselling with one or more persons (ie. relationship counselling, couples counselling, family counselling)
*
Yes
No
Please click any of the issues that are relevant to you. (If you are unsure, don't worry. We can discuss during our consultation).
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Anxiety/OCD
Depression
Interpersonal Challenges
Life Transitions
Family History
Relational Trauma
Self Discovery or Personal Growth
Mindfulness and Wellness Coaching
Other
Have you attended counselling before?
*
Please Select
Yes
No
Are you currently seeing another counsellor?
*
Please Select
Yes
No
Please provide some information about why you are seeking counselling and what you hope the experience can provide. Feel free to be as concise or comprehensive as you like, there are no wrong answers.
*
General Availability (choose all that apply)
Rows
Monday
Tuesday
Wednesday
Thursday
Friday
Weekends
Morning 9am-12pm
Afternoon 12pm-5pm
Evening 5pm-7pm
Submit
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