Welcome to our online booking form to refer children and young people. By submitting the information below, our team will be able to contact you with further information and our available appointments. 

Please Note: This form is for an adult to refer children and young people under the age of 18 only. If you are below 18 , you will need to be referred by a parent or guardian. If you are an adult, to refer yourself, yourself and your partner or your family, click here.

Please check you have read about us and our costs before booking in.

Details of Child or Young Person you are referring:

  

Your Details

Please provide the details below to allow us to contact you about the child or young person's appointment. 

  
MorningAfternoonEvening
Monday
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Wednesday
Thursday
Friday

Counselling payments are calculated on an income-based scale, to accommodate your circumstances. Please ensure you've read our payment policy which can be found here.

Please Note: By requesting to book with us, you will be offered an appointment based on your requirements. There is no obligation to accept this appointment and all information provided is strictly confidential.

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