Please read the information on this page carefully and complete the form below.

What you can expect from us

• A first appointment lasts 50 minutes and is an opportunity to decide whether counselling at CPCP is appropriate for you.
• The number of sessions offered will vary depending on your circumstance and will be agreed with your counsellor. Allocated sessions will be kept for you unless you miss two or more sessions without contact, when these slots will be made available to other clients.
• If you need more specialised help your counsellor will identify the appropriate place and discuss this with you.
• The service offers a free confidential and non-judgemental service to all Clients. Our Confidentiality policy will be explained in your first session.

What we expect from you

• Please arrive on time for appointments.
• If you are unable to keep an appointment we would appreciate notice of cancellation, simply telephone CPCP Help Desk on 020 7638 5440. This means that the session could be made available to another client, especially at our busiest times.

Confidential request form

• Required fields

Title
DR MISS MR MRS MS

First name
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Surname
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Email address
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Telephone number
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Age
-- Please select -- 20 or under 21-30 31-40 41-50 51-60 61-70 71 or over

Gender

Male Female

GP or Doctor's name

Please describe your reasons for seeking out Counselling at this time:

Times when you are available. Please indicate as many slots as possible:

Mon AM Mon PM

Tue AM Tue PM

Wed AM Wed PM

Thu AM Thu PM

Fri AM Fri PM

Do you consider yourself to have a disability?

Yes No

I agree to confidential case notes being kept by and for the sole use of the counselling service staff, in accordance with professional practice, the Data Protection Acts and other relevant legislation. •

I have read and accept all of the above information. •

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