Confidential request for counselling

Counselling is a free service available to all matriculated students. We offer short-term counselling, normally up to four sessions, to help you with any personal problems which might be affecting your academic work or your general health and wellbeing.

Appointments are available 9.30am - 3.30pm throughout the year.

Please complete this form to get an appointment.

(All fields marked with an asterisk (*) are required.)

First name*

Last name*

Matriculation number*

School*

Email*

Mobile number*

Date of birth*

Course title (eg BSc Psychology)*

Year of academic study*

Full time or part time?*

Nationality*

Ethnicity

Gender*

Current GP Practice

Counselling hours run between 9:30am and 3:30pm Monday to Friday during term time. Please indicate in the spaces below what times you are available to meet for an appointment in an average week.

Please note that appointments are typically 30-50 minutes in length so allow yourself adequate space after your counselling session.

Monday

Tuesday

Wednesday

Thursday

Friday

Please explain below your reasons for requesting a counselling appointment, including details on any of the following if they are relevant:*

Recent sudden bereavement, traumatic event, major illness/life change
Thinking of leaving University/consistent non-attendance
Possibility of causing serious to harm to self or others - in this case please also contact your GP for urgent assistance

For academic concerns please also contact your Personal Academic Tutor (PAT) to access support if you haven’t done so already.

Please describe any support/help/resources that you have already used as well as anything else you may have found helpful in trying to manage or address your difficulties and concerns.*

I confirm that I have read and agree to our confidentiality policy and conditions.