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Please state a preferred time that you wish to receive counselling

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Briefly state why you would like to receive counselling

Have you received psychiatric, psychological help or counselling of any kind before?
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Legal disclaimer:

You agree that the use of any or every part of the service is entirely at your own risk. This service is not intended for individuals who are planning to harm themselves or others. If the above is the case, please contact the relevant crisis hotline in your area. Services are provided "as is," without warranty of any kind, either express or implied, including without limitation any warranty for information, services, counselling, uninterrupted access, or products and services provided through or in connection with the service. You recognize that there are no guarantees as to the success of your relationship with the counsellor through this website, and you recognize that during the process of the therapy, psychological pain and distress can arise as difficult issues are addressed and worked through. You also acknowledge that, although Emerge Christian Counselling Centre has taken a number of steps to ensure the confidentiality of your communications with the counsellor, this service cannot guarantee the security of your communications through this website. You agree that the information on this form may be published at a later date although no real names would be used. I agree to forever release, discharge and indemnify George Sukhdeo and Emerge Christian Counselling Centre from all actions, suits, claims arising from receiving counselling on this site.

If you accept the terms of the above disclaimer, please check the box below and then press submit.

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