Client Registration Form

We must advise that our waiting list is currently closed and we are not taking on further clients at present. A list of counselling agencies operating in the Edinburgh area is available at: https://www.edinburghcounsellingagencies.co.uk/Please complete our Client Registration form if you want to enquire about registering for our services

To contact Arkordia for any other reason, please complete our General Enquires form

Client

Your Name

Please provide your full name

Your Email

Please provide your personal e-mail address for us to contact you

Phone

Please provide your mobile or another phone number for us to contact you

Please indicate if you are happy for us to leave a voicemail

Yes

Address

Please provide your address. We are currently only able to take on clients from Edinburgh and The Lothians area.

Postcode

Please enter your Postcode

Service you are interested in

Please select which of our services you are interested in

Your Availability

Available times are Monday, Wednesday, and Friday daytime. Please indicate your availability on these days.

What you are seeking from counselling?

If you are willing to give further information, Please tell us what you are seeking from counselling.

Have you previously received counselling?

Please tell us if you have received any counselling services before

Yes

Further Information

Please use this space to tell us if there is any further information that you would like us to know

If you are human, leave this field blank.

Client Registration Form

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