Young Person Counselling Registration form

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

Where at all possible, this form should be completed with the young person.

Are you filling this form on behalf of yourself?

About you (the young person)

Please make sure the person whose contact is listed is aware about this.

Can we contact you via...

Is your GP aware of your gender identity?

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

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

This service is only provided online.

For example: 1pm-7pm, Monday to Friday;
4pm-7pm, Wednesday

PLEASE LET US KNOW IF ANY OF THE FOLLOWING ARE/HAVE BEEN A CONCERN

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

REASONS FOR SEEKING COUNSELLING

ADDITIONAL SERVICE

Pyramid Youth LGBTQI+ group

StudentSpectra's Youth Group -Pyramid - is for 13-18 year olds who live in London and identify as LGBTQ+ who want a space to socialise with other LGBTQ+ peers, and to find support with their mental wellbeing, identity, and personal development.

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