Online Referral Form

During the national lockdown it might not be possible for our counsellors to meet with you face-to-face, but instead they can use video or online-text or telephone.

So when you fill in the form, if you ask for face-to-face please make sure you also choose at least one other option you’d be happy to use.

REQUEST FOR COUNSELLING

Links below – please contact us before attempting to access.

Please note that TIC+ is NOT a crisis service.

This form may not be read for several days and there is often a waiting list for counselling.


If you or a child/young person is unsafe or if you feel unable to keep yourself safe, please do not delay getting the help you need, contact the most relevant service:

In an emergency call 999 and ask for help or

Contact the Police if a crime has been committed by ringing 101

Go to the Accident and Emergency (A&E) department at your local hospital or

Talk to your Doctor (between 9am-5pm Monday – Friday) or

Phone NHS Direct by ringing 111 (after 5pm or weekends) or

Samaritans: National Freephone: 116123 (24-hours)

Click here for more national and Gloucestershire helplines.

Click here for more national and Hammersmith & Fulham helplines.

If you are parent wanting support and advice for yourself, you can click here for further details about our Parent Support and Advice Line.


We may need to use the information you have provided us with to verify your identity. It is important that you know and fill in the required information before you make your referral otherwise your referral may not be accepted. By making this referral you are accepting these terms.

The online referral form is only available for those who have contacted us directly already. Once you have contacted us, and have read and understood the information above, please click on your area below to start the online referral process.