Sign Up for Counselling

Ready to Take the First Step? We're Here for You.

Sign Up Form

To sign up for in-person counselling, fill in the form below.

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Full name *

Date of birth *

Which of the following best describes you? * If you are aged 11-13 we will need your parents' agreement for you to use our services.

I am aged 14 to 25 in Croydon
I am aged 11 to 25 in Merton
I am aged 11 to 25 in Sutton

Are you a refugee or asylum seeker? *

Yes
No

Are you signing up on behalf of someone else? *

Yes - I am making a referral
No - I am a young person

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If you are making a referral...

Please copy and paste the following link into your web browser to access the referral form for our refugee service: www.talkofftherecord.org/croydon/refugee-service/making-a-referral

Will you need an interpreter? *

Yes
No

What is your first language? *

Are you signing up on behalf of someone else? *

Yes
No

Your relationship to the person you are signing up on behalf of * e.g. Are you a parent, carer, support worker

Your Contact information

Mobile number * Please enter your mobile number

Postcode * Please enter your postcode

Email address * Please enter your email address

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How did you hear about OTR? *

Would you like to join our mailing list? * We'll email you our monthly newsletters. You can update your preferences at any time.

Yes
No

‎‎ * ‎Please check that your details are correct. You only need to submit the form once.

Off the Record is an organisational member of the British Association of Counselling and Psychotherapy (BACP) and follows their ethical framework. Our counselling is person-centred at heart, drawing on a range of humanistic approaches — including cognitive behavioural, psychodynamic, and existential therapies — to support you in the way that works best for you.

Read our data and privacy policy.