Off The Record Counselling Service Willow Lane House 9, Willow Lane Norwich NR2 1EU

~ Waiting List ~

Closed

Unfortunately , due to high demand, we have had to close our waiting list.

Please DO NOT complete the online referral form at this time as any referrals received , whilst the list is closed, will not be processed.

We will reopen our list as soon as we possibly can.

Keep checking back on our website for updates.

Online Application Form

The information you provide on the counselling application form will be used to contact you regarding counselling and appointments as set out in our Privacy Policy.

Please read the information we have on Gift Aid before ticking the Gift Aid boxes on the form.

You can also read and download our information forms by clicking on the link here ~ Client Information Forms

We do ask for a donation for the initial intake assessment appointment and all counselling sessions there with please see How much does it cost?

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COUNSELLING ENQUIRY FORM

Please correct your input in the following fields:

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Name: *

Date of Birth: *

Phone Number: *

E-mail address: *

House Name/Number: *

Post Code: *

Would you prefer a face to face session, remote session or either? *

Can we leave a text ,a voice message or either *

Do you have any problem climbing stairs or need disabled access / other special facilities *

Where did you find out about us?

~~ GIFT AID ~~ AT NO COST TO YOU ! For every £1 you pay of your session donation or any other donation to OTR, OTR receives 25p from the Government. So please tick these first 2 boxes if you pay tax on your income. It makes all the difference.

~~~~ GIFT AID DECLARATION ~~~~ I’m a UK Tax Payer & I’d like OTR to reclaim the tax on all qualifying donations I’ve made, and any future donations. I understand that if I pay less tax than claimed on my donations, I’ll pay the difference.

I am not a UK Tax Payer.

I do not want to Gift Aid my donations

For the Intake Assessment Appointment please state the days & times you are available. Enter either ~ Mornings (9am-1pm), Afternoons (1pm-6pm), Evenings (6pm-8pm), Anytime or if day specific. *

For the Weekly Counselling Sessions please enter either ~ Same, or if different to the Intake Assessment Appointment , the days & times you are available (as stated above) *

Please add any Information here that you feel will be helpful

Captcha (spam protection code): *

I hereby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact and my information being used in accordance with OTR’s Privacy Policy. I am aware that I can revoke my consent at any time.

Note: Fields marked with * are required

~ Waiting List ~

Closed

Unfortunately , due to high demand, we have had to close our waiting list.

Please DO NOT complete the online referral form at this time as any referrals received , whilst the list is closed, will not be processed.

We will reopen our list as soon as we possibly can.

Keep checking back on our website for updates.

Our Recent Donors:

Off The Record appreciate the support they have had over the last year from individual fundraising efforts as well as charitable grants through Norfolk Community Foundation and the Geoffrey Watling Charity, which have helped the organisation continue its valuable work and ensure that counselling remains accessible to all.

Trustees

Paul Burnett

Molly Heron

Angela Perry

Head of Service

Beth Evans

Please contact via

headofservice@otr-norfolk.org.uk

Head of Administration

Lisa Burnett

Please contact via

admin@otr-norfolk.org.uk

Counsellors & Office Staff

Please contact via

info@otr-norfolk.org.uk

The Counselling Directory is a nationwide database of qualified counsellors and therapists which offers an advanced search tool that allows you to filter your search according to your needs and location. Or, if you’d rather receive support remotely, you can find a therapist offering online or telephone services.

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© 2017, Off The Record Counselling Service (Norfolk) Ltd
Off the Record Counselling Service Ltd is a registered charity and a company limited by guarantee.
Registered Charity No. 1088504
Incorporated under the Companies Act 1985, No. 3974890

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