Self-Referral Form

Before we can offer you a consultation appointment, you need to self refer using our webform. No-one else can refer you to our Service. We will offer you a consultation appointment as soon as we have a time that fits with your availability.

  • Togetherall,  the Feeling Good App and SilverCloud are available free to students.
  • Please remember to make an appointment with your GP if you are concerned about how you are feeling.
  • We encourage you to talk to your school if your current difficulties are impacting on your studies, either your Personal Tutor or Student Support Team.

Need urgent help?

Before You Complete the Form

Our self referral form asks for key information about you so we can get you the most appropriate help.   

Before making a referral, you may find it useful to look at some of our self-help resources and the page outlining the counselling process.

Self Help

Our Process

Please also read our Privacy Notice and policy on cancellations.

Complete the referral form now

You need to be a fully matriculated student to access the form. You will be prompted to log in if you haven’t already. 

Important: We will offer you a video consultation via Microsoft Teams.  If you opt for a telephone consultation,  please make sure you add your telephone number to the form and also note in the 'Preferred method of contact' box that you are happy for us to phone you.

Referral Form

If you can’t access the form for any reason, please get in touch.

Contact Us

What We Ask

There are two parts to the form: contact details and availability, and the second part helps you set out the reasons you are approaching us and to enable the counsellor prepare for the assessment.  You can save a draft copy of your form for up to 24 hours before submitting it.

Part One - Your Details and Availability

It’s especially important that we get your contact details right, to avoid data protection issues, so parts of the first section are compulsory.

This section of the form also asks for details of your Personal Tutor/Supervisor. However, we’ll only contact them if you ask us to, or in extreme circumstances.

Privacy Notice

Part Two - Reasons for Seeking Support

The second part helps you set out the reasons you are approaching us and to enable the counsellor prepare for the consultation. This part of the form is not compulsory.

However, it is very helpful to us to know more about why you would like support, so we can make sure you get the right kind of help.


The referral form includes a grid of appointment times for you to let us know your general availability, we will contact you to offer you an appointment based on this.

The more time-slots you’re available for, the easier it will be for us to match you with a free appointment. After you have submitted your form it is important to keep us updated of any changes via the online Availability Update form, we will always offer you a time based on the availbility you've provided.

Appointments are available Monday to Friday daytimes all through the year, including vacation time, with the exeption of winter shutdown btween christmas and new year. Online evening sessions are available Monday to Thursday, semster only.

To Submit the Form

When you have completed the form please click on the GREEN button to submit the form.  You will receive an email confirming we have received your completed form.  

If you are not ready to submit the form you can press the GRAY button to save the form for later completion and submission.  The form will be deleted after 24 hours.    

When you submit the form you will receive an automated email confirming that your submission has been successful and we have received your form.  There is no need to resubmit the form. 

If you don't receive an automated email response you may have pressed the 'save' button in error. 

If you encounter a problem when submitting the form please email to let us know.  We can offer you another method of completing the form.                                                                                                                                                                                                                                      

Referral Form