Referral Form

To access counselling or any of our services, please complete the quick form below and then click submit. A member of our team will then contact you.

The client is the person who will receive our services, the referrer is the person who is making the referral.

THIS SERVICE IS PROVIDED FOR PEOPLE ON A LIMITED OR ZERO INCOME AT A NOMINAL CHARGE OF £1 PER SESSION [PRE-PAYABLE IN BLOCKS OF TEN]

TO DEFINE THE ABOVE WE MEAN ANYONE WHO IS WORKING 10 HOURS OR LESS AND IS IN RECEIPT OF A MEANS TESTED BENEFIT SUCH AS INCOME SUPPORT OR JOB SEEKERS ALLOWANCE.

If you do not meet the above criteria, please refer yourself to one of our low cost partner agencies by clicking here

IF YOU ARE REFERRING SOMEONE ELSE PLEASE MAKE THEM AWARE OF THIS BEFORE PROCEEDING.

We will need a method to contact you, please complete the following:

Please note that when we attempt contact, it is important for you to respond. If you do not respond this may result in your referral being closed. Calls may come from a with-held number.