MAKE A REFERRAL

Looking to make a referral? Want to book an appointment on behalf of someone else? Complete the quick and easy Referral Booking Form below. Thank you!

If you are an third party individual or an organisation referring an individual for one-to-one help and support, please complete both the Referrer Details and Client Detail Sections below to make an appointment. Please seek permission from the individual you are referring before getting in touch.


If you are making an appointment for yourself, please complete the  Appointment Booking Form here. We will respond within 2-3 working days (excluding weekends). Please check your spam folder or re-sent your email if you do not receive a reply within 2-3 working days.

Appointment Booking Form

Please ensure you complete all sections marked * as the form will not send if these sections are not completed. A message will appear below when your form has been sent to us successfully.  We will ALWAYS reply to your email, so if you don't get a reply within 2-3 working days, please check your spam folder or re-send your email. Thank you.

SECTION 1: REFERRER'S DETAILS

 
 
 
 
 
 
 
 
 
 
We will fund open-ended treatment (no specific number of appointments allocated)
The client and therapist will decide this
We will fund a specific number of appointments (please specify below**)
This is negotiable and we will discuss this with Talking EDs
Other (please specify below**)
 
Client (self-funding)
Another individual (please specify in the box below **)
Referring Organisation/Company (please specify below **)
Other (please specify below **)
 
 
Client
Referring Organisation/Company
Relative Friend
Other (**please specify below)
 
 
Client Only
Referring Organisation/Company
Both Client and Organisation/Company
Other (please specify below**)
 
 
Yes
 
 
 
 
 
 
 
 
 
 
Yes
No
 
 
Yes
No
Awaiting Treatment
 
 
Yes
No
 
 
 
 
 
CBT (Cognitive Behavioural Psychotherapy)
Integrative Psychotherapy
General/Humanistic/Person-Centred Counselling
Existential/Exploratory Therapy and Counselling
Rewind Trauma Therapy
Systemic Therapy (currently unavailable)
Clinical Hypnotherapy
Solution Focused Brief Therapy
Guided CBT Self-Help (with a therapist) (currently unavailable)
Stress Management Therapy/Coaching
Coaching
Couples Counselling and Relationship Therapy
Group Therapy (subject to 5-6 clients attending every 2 weeks)
Online Therapy and Counselling
Email Therapy and Counselling (currently unavailable)
Single Session Therapy
Pre-Therapy Consultation
Meal Support (we hope to introduce this in 2022)
Carers Therapy and Counselling
Not Sure
Any approach is suitable
Other (please specify below**)
Discounted Appointments with a Trainee Therapist
 
 
Morning
Afternoon
Evening
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Any Day/Time
Other (please specify below**)
 
 
Face-to-face/In-Person
Online
I am happy to access either face-to-face or online appointments
 
Yes
No
Maybe (please specify below**)
 
 
 
 
Yes
No
 
Search Engine (e.g. Google, Yahoo etc.)
Word-of-Mouth
Beat Listing
Other professional (e.g. GP, therapist etc.)
Family/Friend
Workplace
Counselling Directory
Recommendation
Social Media (e.g. Facebook, Blogger, Twitter, Linkedin etc.)
Other (please specify below**)
 
 
Email
Text
Both
 
Yes
 
Email
Text
Both
Other (please specify**)
 
 
 
 

SECTION 2: CLIENT DETAILS