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Community Counselling Online Referral Form

**We are unable to accept new referrals for Brief Counselling due to excess demand in Ryedale and lack of funding in Scarborough, Whitby and Filey. Please only use the form below to refer for Options counselling and mention this also in your referral.**

We are working hard to secure new funding and will re-open the waiting list for these areas as soon as we can.
Please complete as much of the information required as you can for your Options referral.  We will get in touch with you as soon as possible. Please note that  we are currently only able to offer limited face-to-face counselling as well as online or telephone counselling. 

 

Personal Information
Address
Phone and Email
Details
Referrer Details
Medical Details
Appointment Preferences








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