Referral Form 

We are not a crisis service. Go to the Crisis Support page for sources of help, including NHS 111. 

​​

​

​​​

Please read our Client Contract and Client Consent Form before completing the referral form.

If making a referral on behalf of someone else, please include your name and contact details. ​

​​

If the service is not listed, then the waiting list for that service is currently closed. 

​

The Ryedale brief counselling service is only available to

people living in Ryedale (we are unable to process referrals from people living outside Ryedale).

​

​Fields marked with* must be completed.

​