This enquiry form takes around 4 minutes to complete

Data Privacy Statement
This form is to help us support your enquiry and help get the right support for you.   It collects some personal information to allow us to follow up on your enquiry and to help us match you to the right therapist.  Your data will be kept secure and only used for that purpose.  It will be deleted from this electronic platform once you have been allocated to a therapist.   We do use some of the information (e.g. age information and postcode) to understand our client base better but nothing in that use would compromise your privacy or identify you.

Continuing with this enquiry form will be considered confirmation that you have read and understood this data privacy statement. 

Let's start with some basics

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* 1. Your name

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* 2. Your address

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* 3. Your date of birth

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* 4. Your phone number (mobile if possible since sometimes we text information about appointments)

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* 5. Your email address (if you have one)

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* 6. How would you like us to make contact with you?

And now it would be great to know some more about what you are seeking help for...

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* 7. The main issue I am looking for help with is:

  Main Issue Secondary Issue I don't think this applies to me Not sure
Low mood
Anxiety
Social anxiety
Panic attacks
Relationship issues
Anger
Self-esteem
OCD
Phobia
PTSD
Grief

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* 8. Have you had support through counselling before?

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* 9. Are you on medication related to the issue you are seeking help for?

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* 10. Do you have any contact with psychological/psychiatric services (e.g. CPN or psychiatric) of have you had in the past?

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* 11. Sorry to ask an intrusive question but do you consider yourself to be a risk to yourself and/or others at the current time?

And now we would like to ask you about some of the options we offer

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* 12. Therapy at GCCC is £50 per session.  We offer face-to-face and therapy from our centre on Buchanan St, Glasgow.  We also offer therapy via video (usually Zoom) and phone.  Can you tell us about your preferred platform for therapy:

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* 13. Can you tell us what slots you might be available for therapy sessions bearing in mind that you will most therapy sessions take around 50-55 minutes. Please tick all that apply

  Early morning (before 0930) Morning Afternoon Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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* 14. Is there anything else you think we should be aware of in relation to your enquiry for support?

Thank you for taking the time to complete this enquiry form.  We will process it and get in touch with you in the near future :-)

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