Counselling Referral Form
Our counselling service is a brief 6 session model for young people aged 11+ who live, learn or work in Milton Keynes or the surrounding areas. Counselling is a way of helping with problems or a space to think things out. It's based on building a trusting relationship between you and your counsellor. It can help you talk about your experiences and make sense of them. Counselling can help to express difficult feelings and learn how to manage them in a helpful way.
Counsellors are trained to listen thoughtfully and carefully to your problems without judging or criticising. They do not give advice but support young people to make positive decisions for themselves. Before you start counselling you will have a welcome meeting so you can ask any questions and help us understand the type of counsellor that would be a good match for you. We have a wide range of counsellors with specialised skills and expertise and will always try to make a good fit, however if you are unhappy with your counsellor for any reason (you don't even have to tell us why), let us know and we can put you with someone else.
This form may take up to 10 minutes to complete. Please call us on 01908 604700 if you have any issues or need any help completing this form.
Who is making the referral?
IF YOU ARE MAKING A REFERRAL ON BEHALF OF A YOUNG PERSON PLEASE MAKE SURE THEY WANT COUNSELLING AND KNOW WHAT IT IS. WE ARE UNABLE TO SEE YOUNG PEOPLE WHO DO NOT WANT COUNSELLING AND WILL CANCEL SESSIONS IF THE YOUNG PERSON SAYS THEY DO NOT WANT TO BE THERE OR ARE BEING FORCED TO COME.
I am the YOUNG PERSON wanting counselling
I am a PARENT/GUARDIAN of a young person who wants counselling
I am a PROFESSIONAL working with a young person who wants counselling
NOTE TO CAMHS PROFESSIONALS
This form is for our general counselling referrals only. If you are making a referral to our CAMHS step-up project - please go to
If you have been given a reference, enter it here:
Please ignore this if you have not been given a reference
A note about any personal infomation you submit:
Some information, such as referral sources or anonymised demographic information may be used to demonstrate our impact or report back to funders/stakeholders. Names and appointment times may be shared with a representative at the location counselling is carried out in order to let them know who to expect and when, however no personal information is shared or the reason you are coming other than for general counselling. For our full data protection and privacy notices, please visit our website or request a copy from
/ 01908 604700.
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This form was created inside of YiS Young People's Mental Health.
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