Referring Into Cygnus

We are open Monday - Friday from 9am - 4:30pm, with our last counselling appointment starting at 3:30pm.

PLEASE ONLY COMPLETE OUR ONLINE REFERRAL FORM IF YOU ARE AVAILABLE TO ATTEND COUNSELLING SESSIONS DURING THESE TIMES.

We are a small charity with a dedicated team of staff and volunteers and are currently unable to offer appointments outside of these times.

This form can be used to refer yourself into our service. Professionals may also use this form to refer clients into our service.

For professionals: Before completing this form, please ensure your client is aware of this referral and has understood the data protection policy relating to the sharing of personal information.

Once a referral has been submitted, you will receive a confirmation message on the screen to confirm that it has been received. One of the team will then be in touch with you/your client to carry out a Triage/Assessment; please note: due to the volume of referrals we are processing, this could take a number of weeks.

Important information: It’s really important to keep us updated with any changes to your contact details once you’ve made your referral, therefore please get in touch if you change your phone number. Unfortunately, if we cannot contact you we are unable to hold appointments open for you when we have other people on our waiting list, and you will be discharged from our service if:

  • We make two attempts to contact you/the client to complete triage/assessment and are unsuccessful
  • If you do not turn up for an appointment without contacting us and we are unable to get in touch with you
  • If you do not attend two or more appointments

This does not mean that you cannot access our service in the future, however, you will need to make a new referral into Cygnus.

Whilst you/the client is on our waiting list, we cannot accept any responsibility for your/their wellbeing or safety.

If you need any assistance in filling out this form please don't hesitate to contacts us on: 01670 853977 or email: admin@cygnussupport.com

By completing this form you are confirming that you have read and understood the above message, and that you are giving consent for your information to be kept and stored by Cygnus Support in line with GDPR and our Privacy Policy.




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

 



Additional Information

Referrer's Details

 
If you answered yes to the question above please give details of the parent/guardian below:

What other services are involved with the client? *

Risk Assessment and Management Details *

Known Risks

Additional Information - Client Needs

Please note: we will try to accommodate sessions within your selected days wherever possible – we would ask you to be as flexible as possible because if you have limited availability this might mean you have to wait longer.
By completing this form you are confirming that you have read and understood the above message, and that you are giving consent for your information to be kept and stored by Cygnus Support in line with GDPR and our Privacy Policy. Visit https://www.cygnussupport.com/privacy-policy/ for our privacy policy or alternatively you can request one via email at admin@cygnussupport.com

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