Education & Training Contact 01462 679540
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Children and Young Person's Referral Form

Please make referrals to our Children and Young People’s counselling service using the online referrals form below.

Please ensure that parental consent is obtained and the form has been fully completed. Unfortunately, we are unable to process referrals without parental consent and all the requested information.

Please be aware that there is currently a waiting list for our Children and Young People's Service, so it may be some time before someone contacts you.

If you require support in the meantime, please call Family Support on 01462 679540, Option 7.

Section 1: Referrer's details

all referrers (parent or school) must complete this section

Section 2: Consent

When referring on behalf of an organisation or school, you must have the consent of the parent/guardian. Please tick the box below to confirm that the parent/guardian has given consent for you to make this referral and for you to be contacted about this child/young person. Note: We cannot proceed with this referral without confirmation of consent.

Section 3: Child or young person's details

Section 4: Further details

E.g. CAMHS, Stand By Me, Cruse, school pastoral support, any other organisations


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