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 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. 

When we receive this referral form, we will contact the client to explain what personal information we have, where it came from and how we will process it. We will also send out our assessment pack to be completed and returned to us via email, post (SAE will be provided) or in person.

The client will have 21 days to return this to us.

If we do not hear from the client, we will assume they no longer wish to access the service. 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: admin@cygnussupport.com

 


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