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Your first name*

Your last name*

Who are you contacting TRCIC about?*

Someone I am supporting in a Professional capacity

Enquiring for support for myself

I am a parent/main carer and the person I am enquiring for is aged 15 years or younger

I am a parent/main carer and the person I am enquiring for is aged 16-18 years

An adult who I care for/support/am concerned about in a personal capacity

Other

Which Trauma Recovery CIC services are you interested in? (select all that apply)*

Butterflies Lived Experience Community

Self-pay counselling for adults

Self-pay counselling for children and young people

Trauma-focused therapy programme for people who have experienced sexual violence

Self-pay trauma-focused therapy programme

Becoming a volunteer

Other (please provide further details)

Please share any further information that you think is relevant at this point

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Information you share with Trauma Recovery CIC will be processed and stored in accordance with current legislation. Please indicate that you understand this and give permission for Trauma Recovery CIC to process and store your data by ticking that the box below.

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Trauma Recovery CIC is a multidisciplinary trauma service providing a safe and confidential space for people in the community in relation to sexual, domestic and/or relational abuse.

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