Get in Touch

Please feel free to get in touch to arrange a free 20-minute phone call to discuss your needs and goals, and to see if we’re a suitable fit. You’re also welcome to ask any questions about how therapy works, or about availability. I aim to respond within 3 days

Please refer to my Privacy Policy for details on data collection and storage.

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Name *

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Last

Date of birth (ddmmyy) *

Telephone number *

Email *

Preferred initial contact method *— Select Choice —TelephoneEmailNo preference

Briefly note the main reason(s) for wishing to start counselling *

What days and times are you available for counselling? *

Type of session preferred *

• In person
• Online
• Either/don’t mind

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I consent to the personal information given here being used to contact me *

• Yes

I understand that my personal information will be used and stored in line with KMJ Counselling's privacy policy *

• Yes

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