Name:Email PhoneWhere is Your Nearest Location?(Required) Liverpool Wirral Chester Southport Do you have a preferred therapist? Please tick(Required) Male (£50 – £80 per session) Female (£50 – £80 per session) Male or Female (£50 – £80 per session) Samantha Dey (Director) £100 session Are you seeking support for addiction? Yes No If yes, would you like a free consultation with one of our addiction specialists about the private group support we offer and our bespoke recovery packages? Yes No Are you in receipt of benefits?(Required) No Yes (proof required) If you receive benefits, you will be eligible for our Zoom sessions (£30 per session)How Would You Like us to Contact You?(Required) Phone Call Text Message Email Availability for Appointments(Required) Morning Afternoon Evening Message:Deposit(Required) I agree to pay 50% of the cost of my first session upfront (after my free consultation) Data Consent I consent to sharing my data with the Southport Counselling Association
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