Counselling and Support Referral
We now have a single referral form for ALL the counselling services we provide to adults, young people and children.
Please also use this referral form for Amparo Counselling, including CYP counselling in Southampton, Hampshire, the Isle of Wight and Portsmouth.
Please note in certain areas, additional information will be required, including:
If referring under our VIDA Occupational Health Counselling:
- please ensure that you include your employer’s details for invoicing purposes.
If referring a victim survivor of domestic abuse to DiAmond in Warwickshire:
- Referrals for adults (19 years and above) will be accepted from Warwickshire Domestic Violence and Abuse (WDVA) service only. The WDVA provider is Refuge.
- Referrals for children and young people (aged 4 to 18 years) will be accepted from Warwickshire County Council children and young people’s professionals or from Refuge.
The referrer (for both adults and children/ young people) MUST specify whether the individual being referred is in safe/ relevant accommodation or not, as part of the referral.
If you do not meet any of these criteria, and / or you would like to make a referral to our private clinic, please visit this link to see details of our charges and referral form.
If you have any queries about our referral process or if you need help completing the form, please contact us for assistance.
You can download a copy of Listening Ear’s Privacy Notice here. This contains information on why we collect your information, what we use it for and your rights in relation to your data. To request access to your personal data, a correction or deletion, please complete this form and return it to us using the details provided.