Name:Email PhoneWhere is your Nearest Location(Required) Manchester Liverpool Southport Wirral Chester Do you have a preferred therapist? Please tick(Required) Male (£50 – £80 per session) Female (£50 – £80 per session) Male or Female (£50 – £80 per session) Samantha Dey (Director) £100 session Are you in receipt of benefits?(Required) No Yes (proof required) If you receive benefits, you will be eligible for our Zoom sessions (£30 per session)How Would You Like us to Contact You?(Required) Phone Call Text Message Email Availability for Appointments(Required) Morning Afternoon Evening Message:Deposit(Required) I agree to pay a 50% deposit towards my first session if I am happy with the free consultation. Data Consent(Required) I consent to sharing my data with the Manchester Counselling Association
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