Please complete the form below if you wish to arrange an Individual intake meeting. We’ll reach out to you by phone or email to arrange a specific date. Intake meetings cost £29 for a session and you will have an opportunity to discuss your contribution for regular appointments at the meeting. If you’re looking to attend with a partner please complete a Couple Counselling Referral.

Name

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I would prefer sessions to be via: *

Visual online (Zoom Pro)

By telephone

Email address *

Contact number *

I am able to receive contact by: *

We will use these details to contact you about available appointments and will not share any clinical or personal data through them. Typically we will use your contact details only to confirm appointments and they will not be shared with your counsellor. Details will be stored for 7 years in accordance with GDPR.

Phone call

Can we leave a voicemail?

Where did you first hear about our services?

Are you currently using any of our other counselling services? *

Yes, please indicate below:

Family Therapy

Couple counselling

Sexual Relationship Therapy

Sex addiction

Do you have any disability or access requirements? *

Yes

If so how can we best accommodate your needs?

If you are in a relationship, does your partner/s know about your enquiry *

Yes

n/a

Has domestic abuse ever been an issue? *

Yes

I don't know

Would you feel safe discussing this in counselling sessions *

Yes, but not with my partner present

Yes, with my partner present

Please outline your availability for an Intake Meeting *

We will contact you to arrange a specific time and date.

Daytimes

Evenings

Weekdays

Saturdays

Thank you for your enquiry.

A member of our admin team will be in touch to confirm your registration and discuss an initial meeting with you. We’ll aim to be in touch over the next few days but please bear in mind that during busy periods this can take slightly longer. In the meantime, if you need to speak to us we can be reached on 0131 556 1527 or by email.

http://www.edinburgh.gov.uk/info/20203/funding_opportunities

About this site

Featured

Apr 27, 2016

Bright Light is a company limited by guarantee with charitable status SCO11989
Registered office: 18 York Place, Edinburgh EH1 3EP. Tel 0131 556 1527
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Apr 27, 2016