CCTS Counselling Referral Form

Please correct the errors described below.

Thanks for approaching CCTS for help. This is a confidential and encrypted form and will only be used by our initial assessment team to enable them to provide you with the best support we can. The form will take around 15 minutes to complete. Thanks.

We will only use this in an emergency
Choose one option that best describes your ethnic group or background
(e.g. your doctors name, the address of the surgery)
(e.g. physical or visual impairment, diagnosis etc)

Thanks for taking the time to complete this form - please submit it using the button below.

Your information will be encrypted.