Booking Form

Request for Support

Is this enquiry for an Adults or Young Person

Your first Name:

Your last Name:

Your Contact Phone Number:

Address

Postcode

Please share the First Name Only of the Young Person to be supported:

Please state the Age of the Young Person:

Your preferred Location:

Wimborne, Dorset - Face to Face

Poundbury, Dorset - Face to Face

Online Video LInk

Home Visit (Under 11s)

Provide a guide to your Budget/Affordability on per session basis £

Please share any information that you feel we should know at this stage:

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Once you submit this form we will contact you to arrange an initial assessment to understand your needs, and expectations, answer your questions and explain how counselling can work, we then use this information to pair you with a suitable therapist.