top of page

In
The
Moment
Counselling

New Client Information

Please complete the following information to proceed with our counselling service.

Your information will be kept securely in line with GDPR policies

Please enter a name, contact number and relationship to you

Emergency contact (for yourself)
Phone call
Text
Email

In the event of technology breakdown which disrupts a counselling appointment or our inability to meet you at the agreed session time, how would you prefer to be safely contacted?

bottom of page