Telephone and Online Counselling Referral Form - Under 18

Please fill out the form below. For any fields that are not applicable please enter N/A.

When giving income you must include any benefits you are in receipt of.

Any session prices quoted below are purely a guide as some complex counselling needs and under 18s will attract a higher fee.

Sessions are £35 per session and are ‘payable via bank transfer’ 48 hours prior to your appointment and in-line with our cancellation policy.

Cancellation policy is 48 hours notice - if outside of this then the session fee is still payable.


Please fill out the name of the parent/guardian below.

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