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What we offer

We know that lots of people are dealing with lots of difficult issues during the Coronavirus episode.  We can offer counselling by video or telephone and we currently have a small number of slots for face-to-face appointments available.  This form is to help us support your enquiry and help us get the right support for you.

 

The form collects some personal information to allow us to follow up on your enquiry and to help us match you to the right therapist.  Your data will be kept secure and only used for that purpose. It will be deleted from this electronic platform once you have been allocated to a therapist.  We do use some of the information (eg: age information and postcode) to understand our client base better but nothing in that use would compromise your privacy or identify you. Continuing with this enquiry form will be considered confirmation that you have read and understood this data privacy statement.

 

Let's start with some basics

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* 1. Due to high demand for student therapists we are currently only able to accept referrals for a qualified therapists Which type of counselling are you looking for?

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* 2. Are you referring from the NHS?

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* 3. Please tell us the name of your GP, Mental Health Practitioner, Support worker or please say Not Applicable

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* 4. Your full name

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* 5. Are you an East Ayrshire Resident?

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* 6. Your address

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* 7. Your Postcode

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* 8. Your date of birth

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* 9. What is your occupation?

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* 10. Are you currently able to work?

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* 11. Your contact  phone number (mobile if possible since sometimes we text information about appointments

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* 12. Your email address (if you have one)

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* 13. We can only hold appointments for 24 hours after we have contacted you as we are extremely busy. Please check your voicemail/text messages regularly to ensure that you do not miss an available appointment

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* 14. Please tell us the name of your GP Surgery & Address 

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* 15. Consent given to contact GP surgery in an emergency?

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* 16. The main issue I am looking for help with is:
Please select only one issue for each row, thank you.
It is not possible for a student counsellor to work with higher risk conditions such as PTSD or for people who are at risk of suicide.

  Low Mood Anxiety Social Anxiety Panic Attacks Relationship Issues Anger Self Esteem OCD Phobia PTSD Grief
Main Issue
Secondary Issue
Secondary Issue
Secondary Issue

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* 17. Or any other issue that you'd like to flag to us that you are looking for help with?

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* 18. Have you had support through counselling before?

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* 19. If you answered yes to the previous question can you tell us a bit more?

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* 20. Are you on medication related to the issue you are seeking help for?

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* 21. If you answered yes to the previous question please provide name of the medication and current dosage.

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* 22. Do you have any contact with psychological/psychiatric services (eg CPN, or psychiatrist) or have you had in the past?

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* 23. Sorry to ask an intrusive question but do you consider yourself to be a risk to yourself and/or others at the current time?

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* 24. If you have answered yes to the previous question please answer the following question. Please read each statement below and think how often you have felt like that way in the last week, then mark the box which is closest to this.

  Not at all Only occasionally Sometimes Often Most or all of the time
I have thought of hurting myself
I have made plans to end my life 
I have thought it would be better if i were dead
I have been physically violent to others
I have threatened or intimidated another person
I have hurt myself or taken dangerous risks with my life
Due to high demand for student therapists we are currently only able to take referrals for qualified therapists.

We offer three main choices in therapy.

1} Working with a qualified therapist at £40 per session or, for most conditions,

2} Working with a trainee at £12 per session. Our trainees are all studying on validated courses and receive supervision for their work with clients.

3} Working with a trainee at no cost for 6 sessions (East Ayrshire residents only) if you are referring via the NHS After the 6 free sessions you will be charged £12 per session. Our trainees are all studying on validated courses and receive supervision for their work with clients

It is not possible for trainees to work with higher risk conditions like PTSD or for people who are at risk of suicide.

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* 25. Please select your preferred option

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* 26.  Can you tell us what slots you might be available for your chosen therapy?  The wider your availability the more timely it is to allocate you to a counsellor. Please tick all that apply.  Mornings are 9am-12pm Afternoons are 12pm- 5pm (last appointment is 4pm).

  Yes No
Monday morning
Monday Afternoon
Tuesday Morning
Tuesday afternoon
Wednesday Morning
Wednesday afternoon
Thursday Morning
Thursday afternoon
Friday Morning
Friday Afternoon

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* 27. Is there anything else you think we should be aware of in relation to your enquiry for support

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* 28. Where did you hear about our services

What happens next

If you've requested to work with a Qualified Therapist we should be able to allocate your case based on the information within this enquiry form and they will be in touch by your preferred method (phone or email) to arrange an initial appointment.  Occasionally we will require some additional information to support that allocation and we will be in touch if that is the case.

If you've requested to work with a trainee therapist we may be able to allocate your case based on the information provided or we may get in touch for additional information via your preferred method.

We are extremely busy at the moment and there is approximately a 3 month wait to see a therapist.

Thank you for taking the time to complete this enquiry form.  We will process it and get in touch with you as soon as we have a counsellor available.
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