Book or Refer

Please ensure you read any relevant service criteria before completing this form.

Please enter information about the young person you are referring below.

Please note that we do not accept Domestic Abuse Referrals or Counselling Self-Referrals for Young People in Salford. Referrals are to be submitted here: www.salfordfoundation.org.uk/sisprofessionals

Please note we are no longer accepting self-funded counselling enquiries. But these will be available soon through our subsidiary Now You're Talking, launching April 1st. Register interest here: www.nowyouretalkingtherapy.co.uk

Please enter your details below so we can contact you about this if necessary

We use this information to triage the young person to the most suitable support service.

Please enter your information below to make a referral

Please enter information about the person you are referring below.

In this section you will provide specific information for this service. Note that victims should be consulted and aware of the referrals as they will be contacted as part of the program.

This Information is for domestic abuse referral. For Perpetrator programs. There must be an acceptance of their actions/abuse. There must be a willingness to change.

This information is required for a referral. Please note in-person may not always be available.

In order to process this referral, we will need additional details to ensure we can work in a safe way with all those involved. If you're referring an adult, please provide information on the former/current partner. If you're referring a child, please provide information on the child's parent/guardian. Domestic abuse perpetrator referrals please add victim details here. Family Mediation please add ex partner details here.