Sign Up for Counselling

Ready to Take the First Step? We're Here for You.

Sign Up Form

To sign up for in-person counselling, fill in the form below.

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Full name *

Date of birth *

Which of the following best describes you? * If you are aged 11-13 we will need your parents' agreement for you to use our services.

I am aged 14 to 25 in Croydon

I am aged 11 to 25 in Merton

I am aged 11 to 25 in Sutton

Are you a refugee or asylum seeker? *

Yes

Are you signing up on behalf of someone else? *

Yes - I am making a referral

No - I am a young person

If you are making a referral... *

If you are making a referral...

Please copy and paste the following link into your web browser to access the referral form for our refugee service: www.talkofftherecord.org/croydon/refugee-service/making-a-referral

Will you need an interpreter? *

Yes

What is your first language? *

Are you signing up on behalf of someone else? *

Yes

Your relationship to the person you are signing up on behalf of * e.g. Are you a parent, carer, support worker

Your Contact information

Mobile number * Please enter your mobile number

Postcode * Please enter your postcode

Email address * Please enter your email address

How did you hear about OTR? *

Would you like to join our mailing list? * We'll email you our monthly newsletters. You can update your preferences at any time.

Yes

Help us prevent spam *

We're an organisational member of the British Association for Counselling and Psychotherapy (BACP) and follow their Ethical Framework for the Counselling Professions. Our counselling is rooted in a humanistic model, drawing on person-centred, cognitive behavioural, psychodynamic, existential and other approaches — to support you in the way that works best for you.

Read our data and privacy policy.