I NEED A COUNSELLOR

This is Our Address: 1A Argyll Street, Stoke, Coventry CV2 4FJ

Telephone: 02476 440095

YOUR DETAILS

Please complete the short registration form, as below. Completing these details helps us with our Administration and gives us your contact details and availability so we can arrange an appointment for you as soon as possible.

Before completing this form, please ensure you read and accept the terms as listed below:

  1. If you are completing this form on behalf of someone else, ensure you obtain their approval to enter their details here and inform them of the other information here. Please also enter your own details where indicated.
  2. You will be expected to respond promptly to phone calls and/or text messages regarding appointments. If you do not respond to three attempts at contacting you, your records will be closed and we will not contact you again.
  3. Due to a high demand for our services, if you do not attend your first appointment without giving at least 12 hrs notice, we will close your records and will not contact you again.  This may also apply to ongoing appointments, at the discretion of the counsellor/management.

[NB – please do NOT use this form for general enquiries about Training our other information, there is a separate form for this – please click HERE ]

Note also that we are now re-opening after a period when we were closed to new clients because our waiting list was very long. However, our waiting list is still significant so you may have a wait of several weeks before you will be able to see a counsellor. Those who are most flexible about their availability are likely to have a shorter wait than those who have restricted availability.

If you are not the person being referred, please enter your name and role here, and ensure you read and accept the requirements listed above this form. If you are referring yourself, please enter 'Myself' in this box.

I have obtained approval from the person being referred to enter these personal details for use by the Light House

YesNo

CLIENT DETAILS

When is the best time to contact you (Please note that we can only contact you between 8.30am and 5pm)?

Can we leave a message regarding appointments(Select one)?

Voicemail OKText OKEither Voicemail or TextDo not leave a message

Do you have any mobility issues or disability that would prevent you accessing an upstairs room?
Have you been to the Light House before?

For security purposes, please tick the box below before selecting SUBMIT

Here is a map of our location – use the /- buttons to zoom….

What Happens next?

Once you are registered, you will be contacted by one of our Admin staff to arrange an appointment. The first appointment is called an ‘Initial Assessment’. At this meeting we will chat to you to find out about you and discuss your needs for counselling. In some circumstances we may ask you to allow us to talk to your medical/psychiatric practitioner if appropriate and relevant. When the Initial Assessment has been completed, and counselling has been agreed as an appropriate help for you, you will be allocated to a  counsellor as soon as one becomes available.

Privacy of your information

Please be assured that all your personal information is kept according to the requirements of both UK law (Data Protection act 1998) and by the Code of Ethics and Practice that we follow as Counsellors. See the Light House Website Privacy Policy for more details.

Client Donations

Voluntary donations from clients help support our work, and although we do not turn people away if they cannot afford to make a donation, this will be discussed during your Initial assessment meeting and you will be encouraged to give as you are able at each session. Normal appointments are available between 8.30am and 5pm; a limited number of ‘out of hours’ appointments are available but are subject to a minimum donation of £30 per session.

We do receive gifts from other supporters, but we are always grateful for donations to support clients who are unable to afford any donations to the work. If you would like to support our work now please select the icon below to be taken to our secure donation site, and you will be able to give either a one-off gift or a regular amount each month. We really appreciate your support!

Please support us at give.net

You can also support our work by shopping online through our new shopping channel Give As You Live – Hundreds of stores will give us a donation if you shop via this page! Just sign up as a shopper, and login to the special page where you will see all the stores that can support our work every time you shop. (note – you need to enter the stores via the special links provided in order for your shopping to be tracked and the donations to be made by the store). Click below to sign up now…

2016-branded-banner-240x400_2503

No Comments

Be the first to start a conversation

Leave a Reply