Phone (Home):
Phone (Work):
Phone (Mobile):
E-mail address:
What is your age:
At home:
At work:
On your mobile:
May we contact you by e-mail:
Reasons for seeking counselling:
Have you had counselling before?:
If so, when and where:
How did you hear of Life Changes?:
Employment status:
When are you available for counselling?
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Is there anything else you'd like to tell us:
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(Both your mobile number and email address need to be entered twice and be identical before you can send the form
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Sometimes when life is hard, we can feel lonely, vulnerable and isolated. It can be hard to talk about what's troubling us, our thoughts and feelings. It may be even harder to know someone we can turn to who will listen to us without judging us.

'Life Changes', is a community counselling service situated in central Southampton, which is independent, confidential and open to all individuals over 18.
The counselling provided by 'Life Changes' offers the opportunity to reflect on life and understand the issues
troubling you. You will not be judged or told what to do. Instead you will be offered the time and space to explore
personal change in a private, respectful environment.

If you would like to make a request for sessions with one of our counsellors, please complete our Self-Referral
Form below.


Please complete this form and press the "send" button. Within a few days of receiving your self-referral,
our Counselling Service Director will contact you to talk through how we can best help you.
Coronavirus update 13/05/2020:

We now have capacity to offer counselling sessions by video-link (Zoom) and telephone. Information about how sessions by video-link and telephone will work can be found here.

You can self-refer to us using the referral or contact form here on our website or by calling us on 07 444 001 845.

Please note we now have the facilities to take online donations via our website.  Look for the DONATE button on the left-hand menu on any of our pages.
Logo for Life Changes
Life Changes - Community Counselling Service
If you would like to donate to Life Changes Counselling then please press the donate button below