This referral Form is the first step in accessing therapy, please complete this form honestly and to the best of your ability, if you need support completing the form please get in contact with the service. Tel: 01634308490

Counselling and Psychotherapy Referral Form 

A referral form aims to help you and your therapist make an informed decision about beginning the work together. In addition, the referral form will be helpful for the therapist to understand more about what is going on for you, and what it is you’d like to achieve through therapy. All information you record on this form, and everything you discuss with Inspire Support Services and/or your therapist will be kept in strict confidence.