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Therapeutic Agreement: & GDPR Compliance Data Protection Please select the box and read, Then fill in name  Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Therapeutic Agreement: In-Person & Online Counsellor: Jayne HillsTherapeutic Agreement: Jayne HillsTherapeutic Agreement: In-Person & Online Counsellor: Jayne Hills Please read […]

Please enable JavaScript in your browser to complete this form.Full Name *FirstLastPreferred Name (if different): FirstLastD.O.B. *Home Address:Contact Telephone numbers: *Email *GP DETAILS *Surgery Name *Address Line 1 *Address Line 2 Postcode *Telephone No. *Next of Kin / Emergency Contact Person I may contact your emergency contact, GP, or emergency services if you become unwell