Children’s Counselling

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Gender

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GP Practice

School

Information about who is making the referral (if different)

Name

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Type of referral

Is this referral for...

Bereavement counsellingCounselling for you diagnosis of a life-limiting illnessCounselling to cope with a loved one’s diagnosis of a life-limiting illness

Please give a summary of the issues you would like to discuss in counselling

We provide counselling in person, online and by phone. What is your preferred method?

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