Get started on your journey with St. Martin's Counselling

Get started on your journey with St. Martin's Counselling: Six free sessions
Please note: Free sessions are only eligable for those registered with a Birmingham GP.

Thank you for reaching out. This form will help us understand your needs and match you with the right counsellor.

All the information you provide is held securely and only seen by authorised staff to allocate you to a counsellor. You can find more in our Privacy Policy.

Please complete this form as fully as possible. If we have to come back to you for more information, it may slow down you getting the counselling you need.

Please be aware that we are not a crisis service, and there are also some serious mental health conditions requiring medical treatment that we cannot provide support with. Please see our Access Criteria for certain issues we cannot provide support with.

About you
First Name
Last Name
Email Address
Phone number*
Date of birth*

DayMonthYear
Date
Your age*
Address*

Street Address

Street Address Line 2

CityCounty

Postcode
Gender identity*
Pronouns (optional)
Would you consider yourself to have a disability*
Ethnicity*
How did you hear about us?*
Other

Your Emotional Needs & Goals
What brings you to counselling at the moment?*

AnxietyLow mood or depressionRelationship difficultiesPTSD (single incident)Historic traumaOther
Something else
Can you tell us a bit more about how this is affecting you?*

0/0
What would you like to get out of counselling?*