This is the application form for the NCS CaPA Service. The CaPA service is available to adults aged 18 years or older who have experienced childhood abuse/neglect.
If you have not experienced childhood abuse/neglect, please read further information on mental health support and services.
Please complete the form below to make contact with us. Once you have submitted your details on the form below, we will then send you an email within two working days with some important information about confidentiality and the HSE National Counselling Service (NCS). When you receive the email from us, please read it carefully and we will then endeavour to make contact with you by phone as soon as possible.
If you cannot access this form or have any difficulty completing it, you can phone us on Freephone 1800 234 112 between the hours of 9am to 5pm Monday to Friday. If you are unable to reach us by phone, please leave a voicemail with your contact details and we will return your call during working hours.
To complete the form below, please enter your details in all of the items marked with an asterisk(*) that are mandatory.
