C.A.R.E. Counselling

A safe place to share


Registration form

 
    
 

   

Registration Details

Please do not feel that this is compulsory it is merely to save some time so that in the session issues can be given full priority and concentration.

Feel free to include or omit any details that you may find invasive.

If this is your first email contact with Care Counselling and you would like a free half hour introductory session-

please put "Introcuctory counselling offer" in the email subject line.

Also use this form to request a session after you have received your free half hour introductory session.

Your preferred counselling option :

Family Name :
Preferred First Name :
Address :
Email Address :
Phone (Hm)

 

Phone (Mobile)

     

 
Gender :
Date of Birth :
Please put times when
available for consultation :
Please include a little of what your
current situation is and very briefly
what issues you are hoping to explore :
 Please copy and paste and send to: pameve@wave.co.nz


 

 

 


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