The Christian Centre for Gambling Rehabilitation provides face-to-face counselling in our Centre situated in London and online counselling for
people, particularly British Chinese Community, affected by gambling harms in England.
Please note we are unable to offer counselling for immediate crisis situations. If you have immediate crisis, please call one of the 24/7 crisis services:

1. NHS Mental Health Services 111 (option 2),

2. Samaritans 116123, or

3. texting “SHOUT” to 85258.

For immediate danger to life, call 999 or visit nearest A&E. If you’re under 19, you can also call 0800 1111 to talk to Childline. Our Services will comply to the confidential principle and GDPR. However, we will only share your information if we are very worried about you or think you are in immediate danger or under the law requirement; For other agencies above, please refer to their privacy policies in their agencies’ websites.

Counselling Enquiry Form

This Counselling Enquiry form must only be completed by the adult client, aged 18/18+ or by the teenager, aged 16/16+ or the affected other (including
spouse/parent/child/relative/friend/professional referrer).
We will contact you within 5 working days after we’ve received your submitted form.
Alternatively, you can call or email our office with phone number directly.
Remarks:“Affected other ” means you are affected by someone who gambles.
“*” indicates required fields

    Consent Statement*
    I give consent for the personal and sensitive information provided on this Counselling Enquiry Form to be kept by your office and for it to be shared within the Counselling Service in order to find me/the child a suitable counsellor or relevant referral. I understand it will be treated confidentially except the above principle/conditions and that this Counselling Enquiry Form will be deleted after having fulfilled the counselling purposes for 7 years.

    YesNo

    Which of the following categories apply to the client?
    Adult Person aged 18 or over 18 years oldAffected OthersChild/Young Person aged 16 -17 years old

    PERSONAL & CONTACT DETAILS*
    1. Your name*:
    Name

    Surname

    2. Please state your preferred pronoun*:

    3. Age*:

    Date of Birth*:

    Type the date directy into the box or use the date picker

    4. What is your address*:

    Post Code*:

    5. What is your contact phone number?*:

    6. When are the best times to ring you back?*:
    Please choose as many options as possible to receive a call from our
    counselling team.

    7. What is your email address?*:

    8. Please let us know how we can contact you?*:
    Text*:

    Voicemail*:

    Email*:

    ABOUT THE COUNSELLING SERVICE
    9. Are you able to come for face-to-face counselling or do you need
    online counselling?*:

    10. How did you hear about the CCGR Counselling Service?*:

    If Other, please state:

    11. Are you currently receiving counselling or therapy elsewhere?*:

    If Yes, please state:
    Name of Service:

    Starting date:

    Type the date directy into the box or use the date picker

    If On a waiting list, please state:
    Name of Service:

    12. Have you ever had counselling before?*:

    If Yes, please state:
    Name of Service:

    Period:
    From:

    To:

    13. Please select UP TO 5 OPTIONS below that best describe your
    reason(s) for seeking counselling*:

    If Other, please state:

    14. What do you feel is the main presenting issue for seeking
    counselling?*:

    15. What days and times can you attend at a regular time each week?*:

    16. Do you have any mobility issues or health conditions that we need to
    be aware of?*:

    If Yes, please specify:

    17. Do you have any learning disabilities or special needs?*:

    If Yes, please specify:

    Thank you for completing this form. When submitted you should receive a Confirmation Enquiry Successfully Submitted response followed by an automated email reply. If not please try again or let us know by email referrals@ccgr.org.uk . Once we receive your completed form a member of the office staff will contact you within 5 working days to confirm your details with a view to arranging an appointment for you ASAP. In the meantime, please contact the office on 020 7833 8626 should you wish.

     


    CCGR 28th Anniversary Seminar:

    Dances with Emotion Archive

     
    Dancing with Emotions:

    Dancing with Emotions” download pdf version

    Written by CCGR volunteer counsellor Natalie Chu


    Contact

    For all enquiries or booking a counselling assessment, please contact:

    Aaron NG (Centre Manager)


    Please call +44 0207 833 8626 on:

     

    Monday to Friday 10:00am – 5:00pm

     

    Email: referrals@ccgr.org.uk

     

    We are unable to provide any of the following: treatment for severe mental health illnesses, medical/medication advice, legal advice.