MAKE A REFERRAL

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 always respond to emails. If you haven't received a reply within 2-3 working days (excluding weekends), please check your spam folder as sometimes emails with links or attachts go there.

Referral Booking Form

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 2-3 working days, please check your spam folder or resend your message. Thank you.

REFERRER DETAILS SECTION

 
 
 
 
 
 
 
 
 
 
 
Yes
No
Maybe (please specify below) **
 
 
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 **)
 
 
Alexandra (Lead/Senior Accredited Psychotherapist and Clinical Director) (£87 per session)
Amanda (Advanced Therapist and Counsellor) (£68 per session)
Erin (Newly Qualified Therapist and Counsellor) (£47 per session)
Jackie (Therapist and Counsellor) (£63 per session)
Jenny (Dietitian) (dietetic and nutrition services are only available alongside seeing a therapist here or elsewhere) (£150 for first session, £98 per session thereafter)
Julie (Therapist and Counsellor) (£63 per session)
Laura (Newly Qualified Therapist and Counsellor) (£44 per session)
Liz (Advanced and Accredited Therapist and Counsellor) (£68 per session)
Marie (Therapist and Counsellor) (£63 per session)
Michelle (Advanced and Accredited Therapist and Counsellor) (£68 per session)
Sana (Therapist and Counsellor) - unavailable
Sue (Therapist and Counsellor) (£63 per session)
Trainee Therapist and Counsellor (£25 per session) - there is currently no trainee on placement at the moment
I am happy to work with any therapist that suits my availability
I have no therapist preference and can work with any therapist
CBT-T, Rewind Trauma Therapy, Coaching, Couples Therapy and Single Session Therapy - please see Price List for fees for these therapies
 
Face-to-face
Online
I am happy to access either face-to-face or online appointments
 
 
 
Yes
No
 
 
Email
Text
Both
 
Yes
 
 
Email
Text
Other (Please specify below) **
 
 
 

CLIENT DETAILS SECTION