Online Treatment Registration Form
If you would like a one-to-one chat with one of our Advisers before you register, contact us here.
Please note that * indicates a mandatory field. Please also read our Online Terms and Conditions.
Please note that submissions via this web form are checked between Monday – Friday, 9am-5pm. If you are submitting outside of these times and require urgent support, please contact our Advisers.
If you are in crisis, please contact the Samaritans on 116 123, or in an emergency please contact 999.
Our service is only funded to provide treatment to those living in England, Scotland and Wales.
If you are outside of the UK, please access Gambling Therapy – a free, multi-lingual online service, via www.gamblingtherapy.org/