This referral form is for staff of Equity Region (part of Great Places Housing Group) to refer customers for counselling. By submitting the information below, our team will be able to contact the customer with further information and our available appointments. 

We will acknowledge receipt of your referral within 3 working days and a member of our team will contact the customer within 5 working days.

Guidelines:

Before referring a customer, please download our detailed guidelines to see if counselling will be suitable for your customer.

Please do not refer a customer for counselling if they are currently in crisis, as unfortunately we are unable to offer crisis support.

If you have any queries regarding whether a referral is suitable, call us on 0161 872 1100 or email us.

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Referral Form: 

 

Referrer Details:

  

Customer Details:

  

Please Note: By submitting this referral form, we will contact the customer with further information and available appointments. The customer will automatically receive an email confirming the submission of this form. 

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