Online Support Referral
***The funding for this service has stopped and we are currently not taking any more referrals.****
To make a referral to our 1:1 Online Support service, please fill in the fields below.
We are committed to protecting your privacy and keeping the information you provide confidential. Your information will not be used for any other purpose and is managed according to the General Data Protection Regulation (GDPR) and the Data Protection Act 2018. For more information regarding our privacy policy click here. By sending this form you grant us permission to process your information securely.
Please note that while the Online Support Service is designed to improve your mental health, it is not counselling. If you would like to make a referral into our regular counselling service, please click here.
Please note that we do require your full physical address, GP details and details of your emergency contact. All three are for emergency use only. Whilst we are working remotely it is necessary to know where you are located, and to know your emergency contacts in case we need to alert emergency services or let someone know if an emergency occurs whilst we are working with you. Without these details, we won't be able to put you on the waiting list.
Please note that this is not an emergency service. If you feel suicidal or like self-harming, please go directly to your nearest A&E. You can also call the Samaritans on 116 123 (24/7) or the LGBT Switchboard helpline 0300 330 0630 (10am-10pm) for more immediate support.
