Online Referral Form

Please contact us before using this form

Please note that TIC+ is NOT a crisis service.

This form may not be read for several days and there is often a waiting list for counselling.

If you or a child/young person is unsafe or if you feel unable to keep yourself safe, please do not delay getting the help you need, contact the most relevant service:

In an emergency call 999 and ask for help or

Contact the Police if a crime has been committed by ringing 101

Go to the Accident and Emergency (A&E) department at your local hospital or

Talk to your Doctor (between 9am-5pm Monday – Friday) or

Phone NHS Direct by ringing 111 (after 5pm or weekends) or

Samaritans: National Freephone: 116123 (24-hours)

Click here for more national and Gloucestershire helplines.

Click here for more national and Hammersmith & Fulham helplines.

The online referral form is only available for those who have contacted us directly already. Once you have contacted us, and have read and understood the information above, please click on your area below to start the online referral process.