Youth Counselling Referral

We accept referrals from young people, their parents (or guardians), school, GPs, CAMHS and other professionals. Please complete the form below ensuring you click ‘save details’ at the end. If you would prefer to talk to someone then please call 01252 815652 and we can complete the form for you.

Please only complete a referral for Youth Counselling if the Young Person who is being referred meets the following criteria

They are aged between 11 and 17 on the date of referral
Live in the Hart District OR go to school in the Hart District OR are registered with a GP in the Hart District (please refer to the map on our Youth Counselling page to check areas included in Hart)
They are aware of the referral, understand what Counselling is and want to attend
They are committed to attending every week.
They are not in crisis
They are not receiving Counselling elsewhere

Referrals that do not meet this criteria will be rejected

Please enter the details for the young person first on the form below (the second section of the form is where the person making the referral enters their details).

We will email the referrer to confirm receipt of referral within 3 working days. If you haven’t heard from us within this time please email 121@hartvolaction.org.uk to make sure we have received your referral.