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This is a text-based online support service, offering free online counselling 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. Please allow 10-15 minutes to complete the registration form; gathering your details helps us to arrange your support quickly. 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, please tell us your date of birth

Date of Birth

About You

Repeat Email

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

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

Pronouns What are pronouns?

Search for an address or postcode

Address not found, please enter manually.

Address 1st Line

Address 2nd Line

Address Town

Address County

Address Postcode

Contact Number

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 No

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

Your answers in this last section help us understand who our services are reaching as well as providing the opportunity for us to suggest relevant projects and additional support options you may be able to access.

There’s also a “prefer not to say” option on all of them and we only want you to provide information you’re comfortable with.

How do you describe your ethnicity

How do you describe your gender?

Please describe your gender

Is your gender identity different to the one you were assigned at birth?

Do you identify as intersex?

How do you describe your sexuality

Do you feel you have a disability?

Is your disability

Are you pregnant or currently caring for a child under two years old?

How do you describe your employment status

If you're a parent/carer, tell us the following, how many dependants do you have?

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

If there’s anything that would support you accessing our services, please let us know here (for example, any accessibility needs, language barriers, preferences around the identity of your worker or any other specialist requirements that will make accessing support easier)

How did you hear about us?

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.

Confidentiality

Your data choices:

Your Support

About You

We need your email to keep in touch

And please provide a secure password

Some general information about you

Postcode Search

Your address

We need your contact details

Please tell us about your GP

Your Background

Please tell us about your background

Please tell us about any disabilities you may have

Please tell us about your work or education

Heard from?

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.

Confidentiality

Your data choices:

Your Support

About You

We need your email to keep in touch

And please provide a secure password

Some general information about you

Postcode Search

Your address

We need your contact details

Please tell us about your GP

Your Background

Please tell us about your background

Please tell us about any disabilities you may have

Please tell us about your work or education

Parental consent

Heard from?