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

If you wish to refer a child or young person who has experienced domestic abuse for counselling, please fill in the form below and a member of our team will be in touch.

 

The following section is for you to fill in your details so we know who to contact about the referral. 

  

Please enter information about the child or young person you are wishing to refer to counselling. Please note, if the child is under 11 years old, you will need to attach a parental consent form.

  

Please note, counselling is available for children in all localities, but the youth groups are only available in Locality 3 (Atherton, Leigh, Goldborne, Lowton, Tyldesley, Mosley Common)

We need information on at least one parent/guardian of child in order to refer them to counselling. Please provide this information below.

TLC; Talk, Listen, Change will normally offer a child/young person an assessment appointment where we will talk through what we may be able to offer and how that might fit with any other support needs.


Depending on the outcome of the assessment, we may offer immediate counselling; place the child/young person on our waiting list; or signpost to other organisations.

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