Counselling in Edinburgh - PF Counselling Service - counselling, psychotherapy, support

Application Form

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To arrange an initial session we need you to complete the following brief form. The form can be completed here or you can print it out and post or fax it to us. All information you supply will be treated in strict confidence.

The current waiting time for initial appointments is 3 to 6 weeks, depending on your availability.

0131 447 0876

Fax: 0131 447 9616

info@pfcounselling.org.uk

Contact Details:
	Full name (including Mr/Mrs/Miss etc.):
	Address:
	Postcode:
	Can we send letters to this address?	Yes No
	Your e-mail address:
Telephone Contacts:
	Home telephone number:
	When is the best time to contact you on your home number?
	Can we leave messages for you at your home number?	Yes No
	Work telephone number:
	When is the best time to contact you on your work number?
	Can we leave messages for you at your work number?	Yes No
	Mobile telephone number:
	When is the best time to contact you on your mobile number?
	Can we leave messages for you at your mobile number?	Yes No
Assessment Appointment:
	What days/times are you available to attend for an initial appointment? The more flexibility you have, the quicker you can be seen. Evenings are our busiest time.
	First choice:
	Second choice:
	Other:
Regular Appointments:
	What days/times will you be available to attend on a regular basis? The more flexibility you have, the quicker you can be seen. Evenings are our busiest time.
	First choice:
	Second choice:
	Other:
Other Information:
	Is there anything else you feel we should know at this stage?
	How did you hear about PF?
Fast Track:
	Fast Track usually offers appointments on Fridays afternoons and evenings. The initial appointment will cost £40, and each weekly appointment thereafter is £40.
	Are you applying for Fast Track?	Yes No