top of page

Enquiry Form

Please use this form to refer your child for therapeutic counselling

Reason(s) for your referral. Tick all that apply Required

In the box below, please ensure you answer the following questions with as much detail as you can:

  • What are the current problems your child is experiencing? Explain the selection above in more detail

  • How long has your child experienced these problems?

  • How do the problems effect their daily life? Think about school and home

  • Why are you seeking support at this time?

Thank you for submitting your enquiry.

We aim to contact you within 7 working days excluding Saturdays and Sundays

bottom of page