Get help

Contact us today to get help

Once you fill in the form your referal will be sent to the selected organisation. They will contact you in the method you request so please look out for their communication with you.

You data is shared only with the selected organisation for the purpose of getting help and is not used for any other purpose. We delete any submitted data to us after after one week.

Refer a child or young person with the form below:

Which organisation?(Required)

In Charley’s Memory

Somerset Counselling Centre

The Space

Wellington Community Counselling

Please see profiles of all these organisations that can help you on our Who we are page.

Kooth is an online service which you can access yourself. Visit the Kooth website here

Please select(Required)

Name (including preferred names):(Required)

Gender(Required)

Prefer to self describe as:

Prefered pronouns(Required)

Prefered pronouns

Date of Birth(Required)

Postcode(Required)

Email(Required)

Telephone(Required)

How would you like us to contact you? (Please tick all that apply)

Phone call

Text

Please list any times when it is NOT possible to make contact (e.g. evenings/holidays)(Required)

Please tell us why you would like to see us.(Required)

Do we need to make adaptments to enable you to access our service?

Phone

This field is for validation purposes and should be left unchanged.