Winter Resilience Form

This form is for people aged 55+ living in Trafford as we currently have funding to support these individuals.

We know the winter months can be a difficult time for many. Particularly those who may struggle to get out and about, be further away from family or need that extra emotional support during the colder months. We'd like to offer free counselling, which can be taken up for any reason you may need in order to help you feel better and more resilient.

People often want to talk through daily life issues, relationship concerns, family issues, loss or bereavement, loneliness or sadness - anything that could be preventing you from feeling happier this winter. We're here to help with that. We can see both individuals and couples and offer a range of ways we can deliver counselling, in order to meet your needs.

Please Note: This form is to self-refer or refer somebody else for free counselling via our Trafford Winter Resilience programme which supports people aged 55+ over the Winter period.

If you are not aged 55+ and do not live in Trafford, please refer yourself via our standard Request to Book Counselling Form here.

1. Making a Referral

If you are referring somebody else, please fill in both Section 2 AND Section 3 onwards.

If you are referring yourself, please ignore Section 2 and move to Section 3.

2. Referrers Details

Please provide your details below. Unfortunately, if you are referring on behalf of somebody and don't provide your details, we will not be able to process your referral. 

  

3. Information of person requiring counselling

  

4. Appointment Availability:

The more flexible your appointment availability, the sooner we will be able to offer you an ongoing appointment.

 

Our counselling hours are:

Monday-Friday evenings
Tuesday & Thursday mornings and afternoons

5. Additional Information

Please Note: By requesting to book with us, you will be offered an appointment based on your requirements. All information provided is strictly confidential.

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