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Welcome to Geof Ellingham Counselling Service

This form is designed to collect key information before you start counselling.

Please complete all pages - it will probably take 15-30 minutes. You will be able to save your progress or If you have a code from a partially completed form, click this link to continue from where you left off.

The information provided on this form will be treated in strict confidence and will not be disclosed without your consent unless required by a court of law.

Personal Details

You will need to be at least 18 years old to proceed with this form