Please complete this form if you wish to receive counselling, being as detailed as possible so we can help you the best we can.
Please read our Counselling Support page before filling the form for full details on our counselling service, our approach, referral criteria and fees.
Even though we aim to respond sooner, our response time can be up to 10 days. Inspirited Minds is not an emergency service. If however, you require urgent attention, please follow the link here to see the various organisations you can contact.
Once you have submitted the form below you can track your support request by logging in to our Online Support Centre. Your login details will be emailed to you.
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