Request Counselling

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 arrange an initial session we need you to complete the following form. The form can be completed here, or you can print it out and post it to us. All information you supply will be treated in strict confidence, as detailed in our Privacy Policy, but you do need to consent to us holding and processing your data.

Because of the Christmas break next month, we may not be able to offer you an appointment before January.  However, requests will be processed in the order in which they arrive, and you will be offered an initial session at the earliest opportunity.

We aim to offer initial sessions face-to-face if possible.  However, during periods of lockdown we may only be able to offer remote sessions (video or telephone).  It is therefore important that you read our guides to Video or Telephone sessions, and consider which would be possible for you.  Due to the uncertainty of the months ahead, we cannot accept requests if you can only meet face-to-face.

To request counselling, please complete this form…

    Your Contact Details

    Title (Mr/Mrs/Ms etc)
    First name:
    Surname: *required
    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


    PF Young Adults: We can offer shorter term counselling to young adults (aged 18 to 25 inclusive) on a Saturday through our PF Young Adults service (click here for more details).

    Are you interested in PFYA?    No    Yes

    This service is only available to those under 26 who can attend on Saturdays.

    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:   
    Second choice:   
    Remote Sessions - please select the type of session you are able to attend:  
    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:  
    Second choice:   
    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

    Please click here to verify:

    Click the 'Send' button to submit your form: