Help Counseling | Apply for Counselling

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Apply Online

Our waiting list is up to 4 weeks for an initial appointment and up to 24 weeks for counselling to begin.

To apply online for counselling, please complete the form below and make the £10 initial assessment fee. Once received we will contact you to arrange an Initial Assessment. This appointment is not a counselling session and is conducted between 9am and 5pm with one of our senior counsellors.

If you are unable to apply online, please call us on 01225 767459 and we will send you one of our packs.

HIGH DEMAND SERVICE

We are experiencing high demand for our service. We want to help as many people as possible but hundreds of potential spaces are being lost for varying reasons. This wastes thousands of pounds and creates long waiting times.

Important Notice & Agreement

Please read the following statements carefully before applying.

We offer Online and Telephone to anyone with a disability or a mobility issue.
Service available to West Wiltshire residents only.
If you have had counselling with us before, you must wait 18-months from your last session.
Sessions are weekly, same time, same day. No floating/fortnightly sessions.
Missed appointments (more than 2) result in termination.

I agree to commit to the counselling process and follow the framework above.

Health Declarations

If you are unable to agree to the following, please visit your GP or Community Mental Health Team.

I confirm I am NOT suffering from a mental health disorder (Bi-Polar, Psychosis, PTSD, Eating Disorder).

I confirm I am NOT suffering from a Drugs or Alcohol Addiction.

I confirm I am NOT currently receiving Counselling.

Registration Details

Title

First Name*

Surname*

Address Line 1*

Address Line 2

Town*

County*

Postcode*

Email Address*

Home Telephone

Mobile Number*

Date of Birth*

Marital Status*

Gender Pronoun*

Employment Status*

Dependants (Under 18)

Dependants (Over 18)

Ethnic Origin*

Preferred Method*

How did you hear about us?*

Interested in Volunteering/Fundraising?

Donation & Financials

Contribution per session* * Please only select £5 if annual income is less than £20,000

Gift Aid?

Family Income (Per Year)	Suggested Contribution
Under £20,000	£5 per session
£20,000 to £30,000	£10 per session
£30,000 to £35,000	£15 per session
£35,000 to £40,000	£25 per session
£40,000 +	£30 to £50 per session