Referring Into Cygnus

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


We are a small charity with a dedicated team of staff and volunteers and are 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 that it has been received. One of the team will then be in touch with you/your client to carry out a Triage/Assessment (Due to the volume of referrals we are processing, this could take a number of weeks).

We will make two attempts to contact you/the client. If unsuccessful, we will write to you by post asking you to get in touch. If we don't hear back within the stated time, we will assume you/the client no longer wish to access the service, and we will close the referral on our system.

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 the client is on our waiting list, we cannot accept any responsibility for 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:



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 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