Register new account

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.

First, tell us a little bit about you

To get started, please tell us your date of birth

Date of Birth

Which of the following best describes you?

I am aged 26 or older and study in Croydon

Because you are aged 11-13 we would like to be able to contact your parent/carer or a trusted adult with some information about our service. We will be in touch once you've registered to check that you agree to this. If you have any questions or feel unsure, please email onlinecounselling@talkofftherecord.org

I am aged 11 to 25 and registered with a GP, or live, or work, or study in Croydon

I am aged 26 or older and live in Merton

I am aged 11 to 25 and registered with a GP, or live in Merton

I am aged 26 or older and live in Sutton

I am aged 11 to 25 and registered with a GP, or live in Sutton

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Croydon 26 to 100 (Greater Manchester)
Croydon 11 to 25 (Greater Manchester)
Merton 26 to 100 (Greater Manchester)
Merton 11 to 25 (Greater Manchester)
Sutton 26 to 100 (Tameside and Glossop)
Sutton 11 to 25 (Tameside and Glossop)

None of the above apply to me.

Great! You are eligible to sign up.

First use the form below to tell us a little more about yourself, and what services you would like to use.

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

Our online services are for young people aged 14-25. In order to register for these services as a young person, you need to fall within this age range.

Confidentiality

At Off the Record it’s important to us that things are kept private and confidential. Any information you share with us won't be passed on to anyone outside Off the Record unless we were concerned that you or someone else was at risk of serious harm. Even then, we would always try to talk to you about this first if we can.

Please read our data & confidentiality policy to find out more. If you’d like to ask us about anything, you can reach us at onlinecounselling@talkofftherecord.org.

* I agree to the data and confidentiality policy

We also want it to be your decision to come to us, and it’s important you don’t feel pressured or forced into doing so.

* I confirm I'm filling in this form myself and want to access the services from Breathe Test Domain 2

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.

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

Your Support

The following services are available in your area:

Workshops

Free and informal online workshops, designed to provide practical help and information about key issues you might be struggling with in your life.

For more information about Workshops, click here.

Online Counselling

Free online counselling, giving you one-to-one support to help you through tough times.

For more information about Online Counselling, click here.

Which service would you like to register with? (Please note you can register for one or more services) *:

Workshops

Online Counselling

Accessing one to one support…

In person

Text-based

Phone-based

Video-based

Self-guided SilverCloud

To help get things started, please write a few sentences (approximately 50-100 words) to tell us a little bit about why you are registering for our service(s):

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

Tips on creating a secure password

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

Pronouns What are pronouns?

Postcode Search

Search for an address or postcode

Address not found, please enter manually.

Your address

Address 1st Line

Address 2nd Line

Address Town

Address County

Address Postcode

We need your contact details

Contact Number

In addition to messages on this site, how would you like us to communicate with you? (you must pick at least one option)

By e-mail *

By text

By phone

Leaving voicemails

Through the post

Can we text you?

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 select below.

Yes No

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

Emergency contact

As part of our commitment to your safety and wellbeing we require the details of someone we can contact in an emergency.

Name

If this person knows you by a different name, please let us know this

Contact Number

What is your relationship to the emergency contact?

Emergency contact relationship other

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.

Please tell us about your background

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

Sexuality

Please tell us about any disabilities you may have

Do you feel you have a disability?

Is your disability

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

Please tell us about your work or education

How do you describe your employment status

Education (School/College)

Parental consent

Please provide your parent/carer's email address

Please let us know what school/college or educational institution you are attending

Please provide your parent/carer's name

Please provide your parent/carer's phone number

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)

Heard from?

How did you hear about us?

Heard about us from another