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Home | Get Help | Help Services | Counselling | Counselling referral form

Counselling referral form

Please fill in this form if you would like counselling for yourself or a child in your care.

Step 1 of 2 - Personal details

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  • Please use this form to tell us about yourself and why you would like counselling.

  • Personal details

  • Counselling referral form for 11-15 year olds

    This form should be completed on behalf of the young person who would like counselling. Both parent/carer and young person should be in agreement that this referral for counselling is completed. If your child is between 16 and 18, they can fill in their own form, or you can still do it for them if they would like your support.

  • Personal Details – Parent/Guardian/Relative (emergency contact)

  • Personal Details- Young Person who will receive the counselling

  • Contacting you

  • Information about the person who has been missing

  • More information about suitability for counselling

  • The data we collect through our counselling service is held securely for a period of 6 years. After this time it is deleted or it may be anonymised for research and training purposes. You have the right to ask for access to your data and to request we delete it at any time.

  • How would you like to hear from us?

    We would like to keep you updated and give you the opportunity to support our campaigns and vital work. Please tell us how you would like us to contact you. You can find out more by reading our FAQ. How would you like to hear from us?

  • Please enter a phone number. above.

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© 2021 Missing People | Registered charity in England and Wales (1020419) and in Scotland (SC047419). FREEPOST Missing People 284 Upper Richmond Road West, London SW14 7JE.
All rights reserved. The words Missing People and Runaway Helpline are registered trademarks of Missing People Ltd.

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