Elmroom Counselling Enquiry Form

Name

First Name

Last Name

Email

Phone

(###)

###

####

Message

Preferred Method of Contact

Email

Phone

Text

Availability

Are you interested in:

Face to face counselling

Online video counselling

Not sure yet

Other Information

Is there anything else you would like me to know before we speak? (e.g., accessibility needs, preferred pronouns, previous counselling experience)

Data Protection and Consent

By submitting this form, you agree to me contacting you for the purpose of arranging counselling services. Your information will be handled confidentially and stored securely in accordance with GDPR I consent to Elmroom Counselling storing and using my data to contact me regarding therapy services.

Yes, I consent

Thank you for your interest in counselling with Elmroom. Please complete the form below to help us begin the process of arranging an initial conversation. All information provided will be treated confidentially and in accordance with data protection regulations.

Prefer to Call or Email?

If you’d rather not fill out a form, you’re very welcome to get in touch with me directly.

You can reach me by phone or email to arrange your free 30-minute initial phone call or to ask any questions about counselling. As I’m often in sessions during the day, I may not be able to answer your call straight away — but please feel free to leave a voicemail, and I will get back to you as soon as I can. I aim to return all calls and emails within 48 hours, Monday to Friday.

Phone: 07518028479
Email: vikki@elmroom.com

If you choose to leave a voicemail, it’s helpful if you can mention your name, a contact number, and whether it’s okay for me to leave a voicemail or send a text in reply.