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NECS - Client registration form website
Government advice around Covid-19 means that we can no longer offer face to face counselling. We will provide counselling by Zoom or telephone so please let us know your preferred option.
In order to register for counselling we need to collect some information from you. We will email you a copy of our privacy policy once you have registered but you need to know that we are obliged to keep your information for 6 years.
We want counselling to be a positive experience for you, so we offer a consultation as the first session. This enables us to find out more about your situation and ensure we provide you with the right counselling if it's appropriate and find you the most appropriate counsellor. Our counselling sessions cost £40 for a 50 minute session, or after the first appointment £25 for a 25 minute session.
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How did you hear about us?
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Your name
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Prefix
First
Last
Your email
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Your telephone number
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Can we leave a message on this phone?
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Please select
Yes
No
Can we text you on this phone?
*
Please select
Yes
No
Can we identify ourselves as NECS?
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Please select
Yes
No
Your address
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Street Address
City
State / Province / Region
Postal / Zip Code
Date of birth
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DD
/
MM
/
YYYY
Marital status
*
Please select
Civil Partnership
Cohabiting
Divorced
Married
Partner
Separated
Single
Widowed
Ethnicity
*
Please select
White - English / Welsh / Scottish / Northern Irish / British
White - Irish
White - Gypsy or Irish Traveller
Any other White background
White and Black Caribbean
White and Black African
White and Asian
Any other Mixed / Multiple ethnic background
Indian
Pakistani
Bangladeshi
Chinese
Any other Asian background
African
Caribbean
Any other Black / African / Caribbean background
Arab
Any other ethnic group
Who are you registering for?
*
Please select
Myself
Myself and my partner
Child under 18
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