Booking Form - Family Clarity

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Counselling Booking Form

Thank you for choosing Family Clarity UK. Please complete this form as accurately as possible. The information you provide helps us understand your needs and ensures we can provide you with the most appropriate support. All information is treated confidentially in accordance with our Privacy Policy and applicable data protection legislation.

Full Name

Preferred Name (If Different)

Age

Gender

Male Female

Address

Postcode

Phone Number

Email Address

What has brought you to counselling?

What would you like to achieve through counselling?

Please confrim the following:

I confirm that the information provided is accurate to the best of my knowledge. I understand that counselling is confidential except where there is a legal or ethical duty to protect myself or others from serious harm. I have read and understood the Privacy Policy. I consent to Family Clarity UK storing my information securely for the purpose of providing counselling services. I understand I may withdraw my consent at any time, subject to legal obligations.