Register for Online Support

Register new account

This is a text-based online support service, offering free online counselling and workshops to young people aged 11-25 in Croydon, Sutton and Merton.

To access our services you'll need to tell us a bit about yourself and register for an account. This only takes a minute or two and it's important that we get all the information at the start so that we can best support you. For more information about how we keep and use your data, please see our data policy.

If you are having any problems completing this form, please email onlinecounselling@talkofftherecord.org

First, tell us a little bit about you

To get started, let us work out your age

Date of Birth

About You

We need your email to keep in touch

Repeat Email

And please provide a secure password

Password

Password length shouldn't be shorter than 8 characters
Password must contain at least one special character
Password must contain at least one digit
Password must contain uppercase and lowercase letters

Password Confirmation

Some general information about you

Display Name

Please pick a display name that is not your name, email address or a username you use regularly on other sites, so that you feel able to use our online support services in confidence

First Name

Last Name

Tell us your address

Address 1st Line

Address 2nd Line

Address Town

Address County

Address Postcode

Can we contact you at this address?

We need your contact details

Mobile Phone Number

Can we contact you on this number?

Home Phone Number

Can we contact you on this number?

Can we text you?

If you would like to receive a text message to let you know when you have been allocated a counsellor or to remind you when you have an appointment, please tick below.

Yes, I would like to receive text reminders No, I do not want to receive text reminders

Please tell us about your GP

Your Doctor/GP's Postcode Search

Please make sure you add the name of your GP surgery and the address. In line with our data and privacy policy, we will not contact your GP without your permission or without contacting you first. We do require this information in order to complete your registration, however if for any reason you are unsure about providing these details, please email onlinecounselling@talkofftherecord.org

Your Doctor/GP's Name

Your Doctor/GP's Practice

Your Doctor/GP's Address

Your Background

Off the Record is committed to ensuring we are fully supporting the needs of the whole community and that we are providing accessible and effective services. As part of this, we contribute to national NHS programmes aimed at monitoring and improving mental health services by sharing data with NHS England (please see our data policy for more information).

Whether or not you consent to us sharing your data won't affect your services with us in any way.

Your data choices:

Consent for anonymous data to be used for monitoring the quality of our services with NHS and similar funding bodies

Please tell us about your background

How do you describe your ethnicity

How do you describe your gender?

Please describe your gender

Do you identify as Trans (Yes/No)?

How do you describe your sexuality

Sexuality other

Please tell us about your work or education

How do you describe your employment status

If you're a parent/carer, tell us the following

How many dependants do you have?

Please tell us about any disabilities you may have

Do you feel you are disabled in any way?

Is your disability

Are you, or have you been, in care?

Not sure? Find out more about what this means here

Please select the locality where you are, or were, in care

Are you a young carer?

Not sure? Read more about what a young carer is here

How did you hear about us?

Heard from another

Register for Online Support

Register new account

First, tell us a little bit about you

Great! You are eligible to sign up.

Sorry, unfortunately you're not eligible for our online services.

Services & Reasons for Registering

Workshops

Online Counselling

About You

We need your email to keep in touch

And please provide a secure password

Some general information about you

Tell us your address

We need your contact details

Please tell us about your GP

Your Background

Your data choices:

Please tell us about your background

Please tell us about your work or education

If you're a parent/carer, tell us the following

Please tell us about any disabilities you may have

Nearly there.

Register for Online Support

Register new account

First, tell us a little bit about you

Great! You are eligible to sign up.

Sorry, unfortunately you're not eligible for our online services.

Services & Reasons for Registering

Workshops

Online Counselling

About You

We need your email to keep in touch

And please provide a secure password

Some general information about you

Parental consent

Tell us your address

We need your contact details

Please tell us about your GP

Your Background

Your data choices:

Please tell us about your background

Please tell us about your work or education

If you're a parent/carer, tell us the following

Please tell us about any disabilities you may have

Nearly there.