Young Person Counselling Registration form

If you are applying for someone else, please tell us your name, relation to the client and your contact detail in case we need further clarification. Or is there anything else we should know about this application?

Emergency Contact

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?

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