Counselling Service Referral Form

MM slash DD slash YYYY
Referral method into College Counselling Service
GP Address (if known)
This form will be seen by the Counselling and Wellbeing team and you will be used to contact you for appointments with the service. If we are unable to contact you by the means given above, we will use your personal contact details on the college system. *Please be aware that if you do not consent we may be unable to process your referral.*