New Client Questionnaire

As your first step to get started with Online Counselling, please complete the form below. This is a confidential questionnaire to help us both ascertain if online counselling is the right form of support for you. You are not committing to anything by completing the form and there are no right or wrong answers, it simply helps me to asess your circumstances and ensure that you receive the best quality of care. Please rest assured that any details you submit will remain totally confidential. I will contact you via email within 48 hours of receiving your form.

Nb. if you are under 18 years of age or seeking help for a young person, please click here

Yes, I am interested in Online Counselling:

Can't see the form below? click here to submit it directly via Hushmail

Details sent via this form are protected using SSL encryption from Starfield Technologies and Hushmail. Your submission will be accessable only to UK Online Counselling.

Please note: Web-based counselling is not suitable if you are in acute distress. In case of emergency please contact your GP, local A&E department or call The Samaritans free on 116 123 (UK & ROI) or by email Or for additional support services please click here