About you

Thank you for applying to our counselling service. Please note, we are a women only counselling service, working with women aged 18 and above. We are also not able to provide counselling to counselling students as most of our counsellors are also trainees. It is important you provide clear and detailed answers to the questions below. Your answers will be treated in the strictest confidence. Completing this survey is not a guarantee that we will be able to offer you a counselling assessment as we may not feel our service is the right one for you. We will aim to contact you within ten working days to let you know the next steps. If you do not hear from us within that time, please email amanda@watfordwomenscentre.org.uk

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. Your preferred name, if different from the one you entered above.

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* 4. What is your email address?

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* 5. How did you hear about Watford Women’s Centre (WWC)?

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* 6. Mobile phone number

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* 7. Please state if there are any contact restrictions

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* 8. 1.      What is your date of birth?

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* 9. Are you in paid work?

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* 10. If  yes, what is your occupation?

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* 11. If yes, Is this full-time or part-time?

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* 12. Do you have any personal connection to anyone working at Watford Women’s Centre?  If you have a personal connection to a staff member or counsellor, we will need to take this into consideration when planning your counselling.  In some cases, we may not be able to offer you counselling.

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