Counselling Self-Referral Form At TRC we want to be able to provide the right help for you, and unfortunately and under some circumstances this will not be our counselling service. Before completing the form, please go through the following checks. 1.) If you are currently experiencing a mental health or emotional crisis and are in need of urgent help, counselling is not the right kind of support. Please call the 24-hour Mental Health Matters Helpline on 0800 107 0160 and a trained advisor will help you. 2.) We cannot offer counselling while you are seeing another counsellor or psychological therapist. You will need to end or suspend other therapy, or if it is time-limited we may be able to hold a place for you until your therapy has ended. 3.) We ask clients to attend regular weekly sessions in person at the Women and Children’s centre in Sale. Most sessions are held during the day on weekdays, however there are a limited number of evening slots available, for which there may be a longer waiting list. 4.) Our service relies solely on external funding and as such voluntary donations at the end of therapy are readily accepted. 5.There is a very high demand for our service and unfortunately this can mean a waiting list of up to around 4 months. Thank you for completing the check list. You can now enter your personal details in the form below, or download and complete the form before emailing to us at email@example.com. First Name(required) Last Name(required) Address 1 Address 2 Town/City Postcode(required) Phone(required) Can we leave a message on this number? Yes No Email(required) Please tell us briefly about your current situation and what you would hope to gain from counselling. We will contact you within 14 working days to arrange an assessment, or if we are not able to offer you the right kind of help we will contact you to tell you about what help is available. If you need to contact us for any reason, you can email firstname.lastname@example.org or call us on 0161 968 2820.