Referral Form

Self-Refer or Refer Someone You Support With The Form Below.

Referral Form
Do you give us consent to store and use your information in line with GDPR/Data Protection Principles?
Have you ever been a client at The Therapy Hub.Me? *
Has anyone related to you attended The Therapy Hub.Me for Counselling/Any other service? *
Do you know anyone that works at The Therapy Hub.Me? *
Are you having Suicidal Thoughts?
Self-Harming behaviours? *
Eating-disorder behaviours? *