Information and Contract Form

The following form is designed so you can:

1) Check some of the reasons why online counselling may not be appropriate for you,

2) Supply contact details and specify how you wish to be contacted if it should become necessary

3) Read and accept the ‘counselling contract’

4) Read and accept the ‘terms & conditions’ specific to online counselling,

5) Supply the necessary details for us to be able to connect online

This is an encrypted form .. When you press the submit button your information will be encrypted to safeguard your privacy before it is sent over the Internet

If you feel unable to complete this form it would be difficult (but perhaps not impossible) for us to work together, if this is the case please feel free to email me your concerns.