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  Send a Counselling Referral

Eligibility Criteria

We aim to offer free support to as many young people as we can, however we do have some eligibility criteria that needs to be met. To qualify for our CHAT Youth Counselling services, you must be:

• 8- 25 years old.
• CHAT Youth Counselling are funded for 18–25-year-olds with SEN (Special Educational Needs). For those without SEN, we can support you at our Mental Health and Wellbeing Drop In at Souster Youth, 30 Market Road, Thrapston, NN14 4JU. For more information please call 01832 274422 or email info@chatyouthcounselling.org.uk
• For age 8-10 year olds, referrals to counselling can be done by visiting www.servicesix.co.uk and any Oundle, Thrapston and surrounding area based referrals will be redirected to us here at CHAT Youth Counselling.
• We offer both FACE to FACE and REMOTE SUPPORT (where assistance will be given over the phone or video calls). *Young people under the age of 16 will require parent / guardian consent to download the Zoom application onto personal devices.
• If you are filling in this form for someone else, they need to have given consent before you submit the referral.
• If you are under the age of 13, we need parental consent before offering you an assessment.
• If you don’t know your or give us your NHS number, we will gather this information for you to add to your records. Alternatively, use this link to find your number https://www.nhs.uk/nhs-services/online-services/find-nhs-number/
• For us to be able to book an assessment session, we will need to have your Emergency Contact details and the name of your GP surgery.
• We are not able to offer you counselling / therapy if you are seeing another counsellor or psychological therapist, or if you are currently receiving a high level of Mental Health Care. In those cases, we might be able to offer another service.

Confidentiality

Confidentiality is central to our work, but it is not absolute – there are legitimate exceptional circumstances which require CHAT Youth Counselling to share information with others, such as; if a person is at risk of serious harm by others; if a person is at risk of serious harm to themselves, or to others; or there is a risk of serious crime.

Please refer to FAQ for further information.

CHAT REFERRAL FORM

For a referral please enter as much details as possible to help our process, thank you.

Please note that the information you give on the referral form will be shared with the young person.

Data protection agreement made by completing and sending a referral.

In this form we ask for some personal information, including contact details and information relating to personal history etc. in order to fulfil your request for a counselling or support service with us. Any processing will be performed in-line with the Data Protection Act 1998 and the General Data Protection Regulations. Our registration number with the Information Commissioner’s Office is ZA143894. Please read the privacy policy for counselling and support services to ensure you understand how we process personal data.

Referral Form Submission

Do any of the following Health, SEND or disability categories apply to the client? (Select all that apply)

What issues is the client presenting with (Select all that apply)

14 + 13 =