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Request Counselling

Request counselling below via completion of the intake form

NOTES FOR PARENTS: If you are referring a young person to counselling it is imperative we have the young person's consent. To respect your child’s confidentiality and preserve the integrity of the counselling space, once counselling has begun, I kindly ask that you do not share with me, information about your child. This helps keep the focus on their own experiences (their frame of reference).

If anything important comes up, I will always encourage your child to explore it in their own time. Please note, any information shared will be discussed with them in session.

CLIENT DETAILS TO BE COMPLETED BY THE CLIENT: (Please note: Counselling sessions are held in a confidential and uninterrupted space. All information on this form is strictly confidential and stored in compliance with the Data Protection Act. All information to be encrypted and GDPR Compliant.)

You may wish to include your issues or goals

Preferred method of counselling
In person - Shepperton
In person - Ascot
Online - Zoom
Phone
Walk n Talk (limited)
Birthday
Day
Month
Year

Rest assured, it’s a formality, and I rarely, if ever, need to contact them

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ICO Reference: ZB902891

Full insurance held. Accredited member of the British Association for Counsellors and Psychologists. Accredited member of the National Counselling and Psychotherapy Society.

© 2025 Rob Millist Counselling

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