Appointment Amendment Request Form

Please ensure you complete all required fields to allow us to process this request.

Full Name

Name of your counsellor

Name of your referrer (if your sessions are being funded for you)

Date of appointment booked

Time of appointment booked

Time

Please provide extenuating reasons for rescheduling this appointment

Your session has been booked and confirmed with your counsellor.

We are only able to reschedule your appointment with 24 hours notice and extenuating circumstances provided that you are unable to avoid.

Mobile number

Provide dates and times you would like to reschedule this appointment for

PLEASE ENSURE YOU COMPLETE ALL REQUIRED FIELDS

PLEASE NOTE: If your sessions are being paid for by your Employer, Insurance company, Charity or other Third Party referrer,

we may need to send this rebooking request to them to request authorisation before we can offer an alternative appointment date and time.

PLEASE NOTE: Rebooking requests are only processed during office hours (Monday-Friday 9am-5pm)