Interest in Sessions | Therapy LINCS

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Therapy Lincs

Interest in Sessions Form

This form will allow you to register your interest in sessions directly with your counsellor. It will also help determine if the service matches your needs.
Please complete all the boxes below, with as much or as little information as feels necessary. The information is required for the framework for ongoing therapy sessions. If you have any questions about the storage of data, please visit the Privacy Policy.

Full Name

Gender

Email

Phone

Date of birth

Address including postcode

Availability & Preference

The section helps to be sure the service matches your needs

Have you been or are you in therapy elsewhere?

Emergency Contact

I have read the guidelines for 7 Swans Therapy Lincsin the Terms & Conditions.

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