Online referral form
You can use this form to make a request for counselling.
We may need to use the information you have provided us with to verify your identity. It is important that you know and fill in the required information (found in the FAQ section here.) before you make your referral otherwise your referral may not be accepted. By making this referral you are accepting these terms.
The online referral form is only available for those who have contacted us directly already. Once you have contacted us, and have read and understood the information above, please click below to start the online referral process.
Talk Well is not a crisis service
This form may not be read for several days and there is often a waiting list for counselling.
If you or a child/young person is unsafe or if you feel unable to keep yourself safe, please do not delay getting the help you need, contact the most relevant service:
In an emergency call 999 and ask for help or
Contact the Police if a crime has been committed by ringing 101
Go to the Accident and Emergency (A&E) department at your local hospital or
Talk to your Doctor (between 9am-5pm Monday – Friday) or
Phone NHS Direct by ringing 111 (after 5pm or weekends) or
Samaritans: National Freephone: 116123 (24-hours)