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EC Counselling Services
Counselling Services in Royston, Cambridge, SG8 & online
CALL +44 07842 922597
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Home
About
My Approach
Fees
Location
Contact
Blog
Application Form
Application Form
First Name
Last Name
Address
Postcode
Phone
Email
Gender
Male
Female
Transgender
Non-binary
Other
Please state the nature of the main problem you wish to discuss
Do you consider yourself disabled?
Yes
No
Is your disability something you wish to discuss as part of our counselling?
Yes
No
Name
Telephone
Will the emergency Contact be aware that you are receiving counselling?
Yes
No
Name of Doctor
Surgery Name
Surgery Address
Any Current Medication (please list below)
Preferred Counselling Method
In Person
Via Zoom
Telephone
SEND APPLICATION
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