Counselling Form - Menslink
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Counselling Form
"
*
" indicat
es
required fields
Step
1
of
2
50%
Are you continuing or re-engaging with counselling?
*
Continuing Counselling
Re-engaging Counselling
Data Collection and Privacy Policy
*
By continuing using this form and providing your details you give consent to Menslink to use this information to provide their servic
es,
including the off-shore storage of your information. Please note that if Menslink is served with a Subpoena by a Court of Law to provide information, Menslink must do so. Likewise, as a Mandatory Reporter, Menslink is required by law to immediately report child physical and sexual abuse to CYPS. More information can be fo
und
in
Menslink’s Privacy Policy
.
I agree
What's your name?
*
First
Last
What's your best contact number?
What's your email address?
*
Date of Birth
*
Menslink’s servic
es
are available for young guys between 10 and 25.
If you fall outside of these age rang
es,
you can find out some more info here.
DD slash MM slash YYYY
What has changed that will allow you to engage with Menslink counselling more successfully?
*
What is different now that will have you attending sessions?
What do you want to work on with your counsellor in your sessions?
*
Do you have a preferred counsellor?
*
Stay with current counsellor
Request to change counsellor
No preference
Do you have any
com
ments aro
und
your current counsellor?
*
Name
This field is for validation purpos
es
and should be left unchanged.
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