Private Individual Referral - The Talking Rooms - Counselling & Psychotherapy in Glasgow
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Private Individual Referral

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1About You
2Contacts
3Referral
4State of Wellbeing
5Sessions
6Referrer
7Submit
Please fill in all fields with the referred's details - you will have an opportunity to fill in your details before submitting.
Name*
DD slash MM slash YYYY
Address*

Your GP

GP Address*

Your Emergency Contact

Emergency Contact Name*

For urgent mental health support please contact your local GP or NHS 24 on 111.

Or contact one of the following crisis services:

Samaritans: 116 123
Breathing Space: 0800 83 85 87
Scottish Women's Aid: 0800 027 1234
Rape Crisis: 08088 01 03 02

When would be a good time for your sessions?*
Select as many as you wish
Referrer Name*
Consent of the Referred*
Personal Data Consent*
This field is for validation purposes and should be left unchanged.
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In Crisis?
  • Need Help?
  • 0141 459 0011
  • info@thetalkingrooms.com
  • Make a Referral
  • In Crisis?
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