Thank you for contacting us about making an appointment with North East Counselling Services (NECS). So that we can offer you an appointment we need to take some details from you in this form. Please complete the form and click submit and it will send the form through to our office. We will then be in touch to offer you an appointment.

If you are registering for a young person, the parent/carer should complete the form and then add the details of the young person.

Counselling with NECS costs £50 per session and we take payment by Paypal before the session takes place.

Your Full Name*

Gender*

Date of Birth*

Address*

Number*

Can we leave a voice message?

Can we send a text message?

Can our staff identify themselves?

Email*

Confirm Email*

Ethnic Origin*

Do you have a preference for counsellor gender?*
FemaleMaleNo Preference

Do you have a preference for the age of the counsellor?*
Under 30Over 30No Prefernece

Presenting Issues*

Would you like counselling at NECS with someone else?*
YesNo