Thank you for completing this form. We understand that the first step is always the hardest.
UPside counsellor's a here to listen to your story and come alongside you on your unique journey. 
Please complete this form as accurately as possible so that we can best assist you.

I am 18 years old or older*

While UPside will provide counselling to people younger than 18 we will require consent from a parent or gaurdian to continue.

The Counselling Request is only for myself*

In order to help us help you best it would be helpful if you could briefly describe here why you are requesting counselling.