Children and Young People’s Counselling Referral Form

Please complete this form only if you are aged 16-17 years, live within 20 miles of Harrogate and would like to refer yourself for counselling.
Self Referral Form

Please complete this form only if you have parental responsibility for the child/young person aged 4-17 years, you have their agreement to participate, and the child/young person lives within 20 miles of Harrogate.
Parental Referral Form

If you are 18 or over, please use our adult self-referral form.