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First name
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Last name
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Email
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Phone
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Date of Birth
Day
Month
Month
Year
Address
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Which counselling membership body are you registered with? Please also provide your membership number.
*
Who do you work with? (check all that apply)
*
Couples
Individuals
Children
Young People 12-18yrs
Families
How many clients do you need?
*
How long have you practiced as a therapist? Please provide details of your counselling qualifications, along with which modality you use in therapy.
*
Do you have a niche client? Which presenting issues do you like to work with or feel you have a particular understanding of?
*
If you don't mind telling us, are you neurodivergent? Do you have experience and/or training of working with neurodivergent clients? Do you have a particular area of neurodivergence you like to work with?
*
Is there a particular area of work you would prefer to avoid? It's okay if there is, we just want to make sure we keep you safe in your practice
Please attach a copy of your qualification certificate.
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Please attach a copy of your certificate of professional body membership.
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