in West Essex

Bereavement Counselling

Please provide us with as much of the following information as you feel able to. We will use this information to allocate you to an appropriate therapist so the more you can tell us the better.

Please ensure that we have full contact details as without them we will not be able to contact you to arrange a suitable appointment:

Please indicate if you are affected by any of the following:




*We will not be contacting your GP as a matter of routine, we ask this question only so that if at any point we have serious concerns about your safety or the safety of others we can take appropriate action.

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