Issues with this form? Contact us:
info@therapycentreservices.com


Counselling Referral Form

Online & Telephone counselling appointments will
be offered within 24 hours
The student is or has in the last 2 years experienced suicidal ideations or feelings of wanting to self-harm
The student has previously attempted suicide or self-harmed (within the last 2 years)


If you have any questions at any time, please email:
info@therapycentreservices.com