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Request Counselling

Reaching out for support can feel daunting, so below are a few anonymous reflections shared by previous clients with permission. I hope they offer a gentle sense of the warmth, safety and support that therapy can provide.

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When you are ready, please feel free to scroll down to the intake form, below. 

How can I even describe my therapist, he is simply wonderful and helpful

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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 or PARENT: (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 issues or goals

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

Clients over 18, and parents

Clients over 18, and parents

ie. If you wish for your young person to be copied into weekly appointment confirmations

Birthday
Day
Month
Year

Rest assured, it’s a legal formality

Emergency contact details are collected for safeguarding and emergency purposes only and would only be used where clinically or ethically necessary.

Download Privacy Policy

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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