Request PFYA

Request Counselling – PFYA Service

Before you fill in this Request Form below, please read the information under ‘Helping You for an outline of how the PF Counselling Service works.

To receive counselling as part of the PF Young Adults service, you must:

  • Be at least 18 and under 26 years old
  • Be available for regular weekly counselling sessions every Saturday for the duration of your counselling
  • Be assessed by us as suitable for shorter-term counselling (up to 24 sessions)

To arrange an initial session please complete the following form. All information you supply will be treated in strict confidence, as detailed in our Privacy Policy, and you will need to consent to us holding and processing your data.

Please complete all details requested…

Your Contact Details

Title (Mr/Mrs/Ms etc)
First name:
Surname: *required
Address:
Postcode:
Can we send letters to this address? YesNo

Email Address: *required
(We will assume we can email you about counselling to this address.)
Telephone Number: *required
When leaving messages, we will always say "It is the PF Counselling Service calling"
Can we leave messages for you on this number? YesNo
If you have provided a mobile number we use text messages to remind clients of their initial appointment only. We will mention PF Counselling Service in this message.
Can we contact you by text? YesNo

PFYA Appointments


The PF Young Adults service offers regular weekly counselling on a Saturday to those aged 18 - 25.

Waiting times for PFYA are currently quite short and you will probably be offered an initial appointment in the next few weeks. Please do not send this form until you are available to attend an initial appointment.
Are you under 26?:
Can you attend appointments every week on a Saturday?   
The PFYA service is only available on a Saturday and to those under 26.


Initial Appointment

What days/times are you available for us to arrange a one-off initial appointment with you? The more flexibility you have, the quicker you can be seen. 
First choice: Saturday
Second choice: Saturday
Would you like to be contacted for a last minute Initial Appointment if one becomes available? (less than 48 hours in advance) YesNo
Please give further details of your one-off initial availability here, if necessary:

Regular Appointments

What days/times are you available to attend for regular weekly sessions? The more flexibility you have, the quicker you can be seen. 
First choice: Saturday
Second choice: Saturday
Please give further details of your regular availability here, if necessary:

Other Information:

Your date of birth: (If the 'date picker' doesn't work in your browser, please leave blank and include this in the text box below.)

How did you hear about PF? Please select an option...
Is there anything else you feel we should know at this stage?
Please tell us about any particular access requirements:
Please indicate your agreement to our careful and confidential use of your data by ticking the box below: *required
I have read the PF Data Protection & Privacy Policy and agree to my personal data being held and processed in accordance with PF policy.

Send Us Your Form

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