Mindspace Young Person Counselling Registration Form

Personal Details








Please enter with NO spaces e.g. PH28EH









Permission to Share Agreement

Permission to Share Agreement






Emergency Contact Details


Additional Information


Counselling Details
Data Protection Statement






Adult Counselling
Unfortunately, our waiting list for adults (18+) is currently closed due to extremely high demand. Please continue to check our website for updates. We care about your well-being and will reopen the list as soon as possible. In the meantime, if you need immediate assistance, please don’t hesitate to reach out to your GP, NHS (111), or Childline at 0800 1111.