This form is to determine whether The Harbour is the right place for you to access counselling at this time. If you would like help completing this form, or would like any further information, please call us on 0117 925 9348.
The Harbour is not a crisis service. If you are in immediate crisis please telephone 0800 953 1919 where you may speak with a practitioner working on the NHS urgent mental health helpline for Avon and Wiltshire, or you may speak with The Samaritans on 116 123.
Please note: Questions marked with a '*' are required.