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1Tell us about yourself
2Why you are referring
3Medical background
    Please note that if you are a third-party organisation you will need to send us an email with further information about your client. Also when referring someone there is a minimum £15 donation towards counselling. Due to popular demand on our service, we regret to inform you that there is now a waiting list for processing new referrals. Unfortunately this can be anything up to 4 or 5 months. If you are happy to wait that long, then please go ahead and make the referral. Once again we are deeply sorry that we can not help you sooner. Please contact MIND or the CRISIS team in your area if you need help. Kind regards Jules CEFO of HIs Charity
  • Third party

  • About you

  • DD slash MM slash YYYY
  • Why are you reaching out?

  • Medical background

  • Ethnicity

  • Next of Kin (optional)

  • Your GP (optional)

  • Finally ...

  • Many thanks for your referral. Someone from the team will give you a bell . There is a 6 weeks assessment process, however in the meantime please use our 24/7 helpline, where you will be put through to a professional counsellor.
  • On a scale of 1 (low) to 10 (high), how urgent is your referral
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