Child & Family - Apply Online
Child & Family Counselling Form
Name (Parent or Guardian)
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Gender
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Address
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Postcode
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Email
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Home Tel. Number
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Work Tel. Number
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Mobile
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Can we leave a message in confidence on any of the above? Please indicate by ticking box(es) below.
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How would you describe your ethnic origin?
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Do you have any disabilities or special needs?
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Are Parental Rights / Legal Proceedings current or pending?
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Who is counselling being requested for:
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Please specify name/s and age/s?
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People living in your home (Please include full name, date of birth & relationship to you):
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Name and age of other people who are important but live elsewhere:
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Is/are the person/s being referred taking any relevant medication?
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If yes please detail:
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GP’s name and surgery:
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Do you know anyone currently in counselling with GCS or working for GCS? If so, please give details.
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Please indicate your availability (time and venue) for weekly counselling)*
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Do you have any planned breaks (i.e. holidays)? If so please give details:
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Counselling Fees
Total Fee 0.00 GBP
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BACP
British Psychoanalytic Council

GCS specialises in providing counselling and training of counsellors to professional standards. GCS was established in 1980 and has over 60 counsellors offering high quality affordable, counselling to the community of Gloucestershire in venues across the county including Stroud, Gloucester, Cheltenham, Tewkesbury and Cirencester. All our counsellors are supervised and managed within GCS and work within the BACP ethical framework. Some of our counsellors are counsellors in training; they work to the same standards as our qualified counsellors.

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