LABAN COUNSELLING - APPOINTMENT REQUEST FORM

Seen one of the counsellors here before?	yes	no
If yes, who & when?

Please select all times you CAN attend an appointment
nb - the better your availability, the sooner the first (assessment) appointment

Claire Rice
Monday	4pm 5pm 6pm 7pm
Wednesday	4pm 5pm 6pm 7pm
(when new counsellor will be appointed)
Tuesday	1pm 2pm 3pm
	4pm 5pm 6pm 7pm
Thursday	4pm 5pm 6pm 7pm

Is there something you need to tell us at this stage about this appointment request?

Please confirm you have seen our Code of Practice page

nb As this form is no more "secure" than emails, if you are concerned about the possibility that this information may be seen by a third party over the internet, do not click the "send form" button - print out the form instead, put it in an enevelope marked "Laban Counsellors" and hand it over to daytime receptionists, or slip it under our door at The Cottages.