Your Route to Therapy, with Manchester Counselling

Your Route to Therapy, with Manchester Counselling

This therapy referral takes about 3 minutes to complete.

This therapy referral takes about 3 minutes to complete.

Before we begin

Your school, university, employer, or another organisation has arranged access to therapy for you through our service.

Your school, university, employer, or another organisation has arranged access to therapy for you through our service.

Here's how it works:

Here's how it works:

Step 1: Complete this referral form

Step 1: Complete this referral form

Step 2: Book a Therapy Advisory Call

Step 2: Book a Therapy Advisory Call

Please share the name of the organisation that arranged your access to therapy

Please share the name of the organisation that arranged your access to therapy

How old are you?

How old are you?

We support adults aged 18 and over

We support adults aged 18 and over

How do you describe your gender?

How do you describe your gender?

More options

More options

What's brought you to therapy?

What's brought you to therapy?

Select everything that applies

Select everything that applies

Thank you for telling us.

Thank you for telling us.

It takes courage to share that you're having thoughts of suicide, and we're glad you did.

It takes courage to share that you're having thoughts of suicide, and we're glad you did.

We want to be honest with you. Our service arranges private ongoing therapy, and that isn't the right support for how you're feeling right now. You deserve help from people trained for exactly this, and it's available today, free, at any hour.

We want to be honest with you. Our service arranges private ongoing therapy, and that isn't the right support for how you're feeling right now. You deserve help from people trained for exactly this, and it's available today, free, at any hour.

If you're in immediate danger, call 999 or go to your nearest A&E.

If you're in immediate danger, call 999 or go to your nearest A&E.

To talk to someone now

To talk to someone now

  • Samaritans: call 116 123, free, day or night

  • Shout: text SHOUT to 85258 for free, confidential support by text

  • NHS 111, option 2: urgent mental health support and local crisis services

  • Samaritans: call 116 123, free, day or night

  • Shout: text SHOUT to 85258 for free, confidential support by text

  • NHS 111, option 2: urgent mental health support and local crisis services

In the coming days

In the coming days

  • Speak to your GP, who can arrange ongoing NHS mental health support

  • Tell someone you trust how you're feeling. You don't have to manage this alone

  • Speak to your GP, who can arrange ongoing NHS mental health support

  • Tell someone you trust how you're feeling. You don't have to manage this alone

For these reasons we won't take your referral further today. This isn't a closed door. When you're through this period and have support around you, we'd be glad to hear from you again.

For these reasons we won't take your referral further today. This isn't a closed door. When you're through this period and have support around you, we'd be glad to hear from you again.

What would you like to gain from therapy?

What would you like to gain from therapy?

Select as many as apply

Select as many as apply

Do you have a preference for your therapist?

Do you have a preference for your therapist?

We'll always try to match your preferences

We'll try to match your preferences

How important are these to you?

How important are these to you?

We'll always try to match your preferences

We'll try to match your preferences

Evening demand

Evening demand

Evenings appointments are in high demand and evening-only requests can limit options. Please consider adding daytime availability if you can.

When are you available for sessions?

When are you available for sessions?

Select the days and time options you could attend a weekly session. Add specific detail about times below.

Select the days and time options you could attend a weekly session. Add specific detail about times below.

Some details so we can get in touch

Some details so we can get in touch

First Name

Last Name

Contact Number

Email

A note on session frequency

A note on session frequency

Weekly sessions are the foundation of effective therapy, helping to build trust and maintain momentum. Therapists work on a weekly basis as this is recognised as the optimal approach for client progress.

Nearly there, just a few things to confirm.

Please open each section below to review before confirming.