SWP Counselling Registration form

Spectra's counselling service is confidential. This means we will not share any information you provided here, or your prefession, with a third party, e.g. your GP, unless you told us to. We keep our client data for 7 years. If your counselling application is unsuccesful, we will remove your data after 6 months. While we have your data, there might be circumstances when we have to share information about you. These could be:

  • when there is a serious concern for your or someone else’s safety, particularly if a child is at risk of serious harm;
  • when there is a legal obligation relating to your involvement in, or knowledge of, a serious crime;
  • when a court order requests information about you;
  • when it is essential to prevent a serious and imminent threat to either public health or national security.

We will always seek your consent before any disclosure.

If you need any support to complete this form, please contact us via counselling@spectra-london.org.uk.

* Required.

About you

Emergency Contact

In any case of emergency, we will always try to contact this person prior to contacting your GP.

In order to arrange appointments we will contact you by phone and email. If you prefer not to receive communication by any of these methods, please untick the appropriate boxes.

Is your GP aware of your gender identity?

Is your current gender identity same as you were assigned at birth?

If you have used any other Spectra services in the past, please provide more details here.
Currently we can offer Counselling in English and French.
In order for us to be mindful of any conflict of interest please could you tell us if you know any staff at Spectra, are in a close relationship with someone who has applied to/ is receiving counselling from Spectra. Or if you are receiving counselling elsewhere.

Your Availability

Appointments will be held either online, by phone, or face to face at our office at St Charles Centre.

Please indicate your preferable time and day(s) of the week for counselling sessions.



this could include but is not limited to: physical abuse; emotional abuse; sexual abuse; domestic abuse; neglect

I would like to subscribe to your newsletter

By clicking I agree with Spectra's policy you agree to the Privacy Policy set out by this site and the data sharing with SOAS as stated at the beginning of this form.