BCPC Referral Service Registration Form

Register with us

Thank you for connecting with the BCPC Referral Service. Please answer the following questions to help us find you a suitable therapist. This information will be anonymised and circulated to our network of BCPC trained counsellors and psychotherapists and our counsellors and psychotherapists in training to see who thinks they could work with you and has availability.

Please do not give very detailed personal information on this form, just give a few brief details of the area you feel you need support with.

If you have any questions about confidentiality or any other aspect of completing this form, please contact the Referral Service Coordinator on 07907 771 612 or email referralservice@bcpc.org.uk

Affordable therapy options are also on offer for those on a low income. Please click here Low Cost Counselling Service

Please note, fields marked with an * are reqired.

Full Name

If Other please specify your first location choice

If Other please specify your second location choice

Email Address

Mobile Phone

If other, please state

How much are you able to pay per session? Our service uses trainees offering low-cost sessions for £20-£40. Those offering sessions for £40-45 may be qualified practitioners or may be late-stage psychotherapists-in-training with significant experience in working with clients. Those charging £50 and over will be fully qualified.

What days and times are you available to see someone on a regular basis?

Please describe briefly what you are looking for support with

Do you have any additional preferences in relation to your choice of therapist?

How did you hear about this service?

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