This referral form is ONLY for schools who are already working with us. If this is you, please use the form below to refer another pupil. 

We will acknowledge receipt of your referral within 3 working days and a member of our team will be in touch to book the client (young person) in. 


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

Email the Team

Referral Form: 

The following section is for you to fill in your details as the referrer.

Please enter information about the child or young person you are wishing to refer to counselling. 


The following section is for you to fill in any details we need regarding the parent/guardian of this child. 

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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