First Name *Last Name *Email *Number Brierfly Tell Me About What Brings You To Counselling. *1. Are you over 18? *YesNo2. Have you been feeling suicidal/attempted suicide in the last 6 months? *YesNo3. Have you attempted self-harm or had thought of self-harming in the past 6 months? *YesNo4. Have you been experiencing any issues with reality testing: that is, are you able to objectively evaluate your own feelings and thoughts against external reality? *YesNo5. Have you been diagnosed/suffering from psychosis in the recent months? *YesNo6. Are you generally familiar and comfortable with using computers, smartphones and the like? *YesNo7. Have you got sufficient hearing to manage video conferencing? *YesNo8. Have you got a sole access to a computer, tablet, smartphone or a laptop with a camera and headset that is password-protected and has an up-to-date anti-virus protection and a secure Wi-Fi? *YesNo9. Have you got access to a quiet room where you can talk without being overheard or interrupted during your online counselling session? *YesNo10. Are you able and willing to provide your GP and an emergency contact details (this is a standard procedure in counselling professions and required for emergency/safeguarding purposes)? *YesNoDeclaration: I declare that the answers provided were answered to my best knowledge and are correct. *YesNoI understand that by supplying incorrect information my suitability for online counselling services may be affected and my safety concerned with the therapeutic process could be compromised. *YesNoPhoneSubmit