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 be used by our initial assessment and consultation team to provide you with the best support we can.

Some questions are included to enable us to monitor the diversity of people requesting counselling and to identify areas for improvement. Thanks for your help with this.

The form should take around 15 to 20 minutes to complete. Once submitted, we will aim to respond to your request within 5 working days.

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)
e.g. Facebook, IG, Twitter, Linkedin etc..

Thanks for taking the time to complete this form - please submit it using the button below and we will get in touch with you.

Your information will be encrypted.

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