Referring Into Cygnus

Please fill out the form below to refer into Cygnus. If you need any assitance in filling out this form please don't hesitstate to contacts us on:

01670 853977 or email:


Client Details (In the case of a self-referral your details)


Additional Information

Referrer's Details

What other services are involved with the client? *

Risk Assessment and Management Details *

Known Risks

Additional Information - Client Needs

(Our opening hours are 9:00am – 4:30pm and our last counselling appointment is at 3:30pm. We can sometimes offer evening and Saturday sessions this is dependent on counsellor availability.)

[*] denotes a required field