Request a counselling appointment
A short form with routing details only: who the appointment is for, what kind of counselling, and how to reach you. Someone from the practice replies to arrange a time — a request on its own is not a confirmed appointment.
Routing details only
Enough for the practice to know who should contact you, in what format, and when you are generally free. Nothing about your health belongs on this page.
Please read this before you fill anything in
- This form asks for routing information only — enough to know who should contact you and in what format. Please do not include symptoms, a diagnosis, medical or medication history, a reason for therapy, insurance card or member numbers, or anything about a child beyond the fact that the appointment is for a child or teenager.
- Do not use this form in an emergency. If you are in crisis, or worried about someone's safety, see crisis support.
- Sending this does not create a therapist–client relationship, and your appointment is not confirmed until someone from the practice replies to arrange a time.
- Private paperwork never happens on this website. When it is time, the practice sends you a secure link.