Appointments

Consultation Request

* Indicates required field

Name *

First

Last

Email *

Phone Number *

We will send you a text before we ring you so as to confirm your name and privacy.

Day for your call back *

We will do out best to call at a time that is convenient to you.

Time *

We will do our best to return your call at your selected time.

Anything specific you wish to ask? *

Fill this out if you have something specific to bring to our attention.

I verify that I wish to be contacted by Cork Counselling Clinic. *

Select

So as to process your call we request that you confirm that you wish for Cork Counselling Clinic to telephone you for a consultation.

Submit Request

* Indicates required field

Name *

First

Last

Email *

Phone Number *

We will send you a text before we ring you so as to confirm your name and privacy.

Anything specific you wish to ask? *

Fill this out if you have something specific to bring to our attention.

I verify that I wish to be contacted by Cork Counselling Clinic. *

Select

So as to process your call we request that you confirm that you wish for Cork Counselling Clinic to telephone you for a consultation.

Submit Request

Appointments:

* Indicates required field

Name *

First

Last

Email *

Phone Number *

When is the best time to telephone you? *

9.00am to 12.30pm 1.00pm to 4.30pm 6.30pm to 7.45pm

Submit Request

* Indicates required field

Email *

I agree to receiving marketing and promotional materials *