Contact booking form

027 382 6854

Email Men and Trauma New Zealand

Home
Contact Us
Who are we
Having Difficulties?
How we can help
Rainbow Services
Resources

Home
Contact Us
Who are we
Having Difficulties?
How we can help
Rainbow Services
Resources

Booking form here

Bookings:
Survivors of Trauma & Sexual Abuse

How Can We Help?

* Indicates required field

Name *

First

Last

You can use a nickname or whcihever name you can prefer. For last name you can just put - or . if you like

Email *

You don't have to leave your phone number but if you don't leave either email or phone number we won't be able to get back to you.

Phone Number *

You don't have to leave your phone number but if you don't leave either email or phone number we won't be able to get back to you.

Address *

Line 1

Line 2

City

State

Zip Code

Country

Which part of NZ do you live in? *

How do you want to be contacted? *

Text Call back to your number Email Face to Face Video

What support method would you prefer? *

Face to face Phone call Video; Zoom or WhatsApp etc.

Do you have any preferences of the person you see? *

Any is fine really Male Female Rainbow sensitive Disabled aware Ethnic preference

If so, which ethnicity are you hoping to see? *

What support are you looking for? *

Intro session 1 - 1 counselling Peer support Group support Support for partners, couples, family or Whanau Help laying complaint with Police Registering for an ACC Sensitive Claim Not sure yet

What difficulties wouuld you like support with? *

I just need someone to talk to Child Abuse Sexual Abuse Victim or perpetrator of Violence Suicidal thoughts and behaviours Out of control feelings and behaviour My life is chaos and I can't get a grip on it Not sure yet

Are there any counsellors in particular on our Staff page you would like to see? *

Is there anything else you would like to mention at this stage? *

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