MAKE A REFERRAL

GLASGOW ANXIETY & DEPRESSION SUPPORT SERVICE

Looking to make a referral? Want to book an appointment on behalf of someone else? Complete the quick and easy Referral Booking Form below. Thank you!

If you are an individual or organisation referring a third party individual for one-to-one help and support (see the Services and Support sections in the Menu above for  information on the one-to-one services provided), please complete the Referrer Details and Client Details Sections below to make an appointment. Please seek permission from the individual you are referring before getting in touch.


If you are making an appointment for yourself, please complete the  Appointment Booking Form here. We will respond within 2 working days (excluding weekends).

Please ensure you complete all sections marked * as the form will not send if these sections are not completed.  A message will appear below when your form has been sent to us successfully. We will ALWAYS reply to your email, so if you don't get a reply withing 2 working days, please check your spam folder too. Thank you.

REFERRER DETAILS SECTION

 
 
 
 
 
 
 
 
 
 
Client (self-funding)
Another individual (please specify in the box below **)
Referring Organisation/Company (please specify below **)
Other (please specify below **)
 
 
Client Only
Referring Organisation/Company
Both Client and Organisation/Company
Other (please specify below **)
 
 
I confirm the above
 
 
 
 
 
 
 
 
 
 
Yes
No
 
 
Yes
No
Awaiting Treatment
 
 
Yes
No
 
 
 
 
 
 
 
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Any Day/Time
Other (please specify below **)
 
 
 
 
Yes
No
 
 
Email
Text
Both
 
Yes
 
 
Email
Text
Other (Please specify below) **
 
 

CLIENT DETAILS SECTION

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