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Counselling referral form

Person referring

On behalf of / self referral

Date of referral

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Age

Client contact number and email (if available)

Reason for referral

Any other relevant comments or further information

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Birchwood is a company limited by guarantee registered in England and Wales under number 03383296 and registered as a Charity number 1064270

Birchwood's Response to COVID-19

As this time of great uncertainty and worry the individuals, families and local communities that rely on Birchwood services remain at the heart of all our decisions and we will continue to ensure they continue to be our number one priority.

Self-Isolation doesn't have to mean social isolation' project, is a Birchwood In the Community response to the coronavirus crisis and provides timely and vital support to extremely vulnerable individuals and families within our local community. The response and feedback has been amazing and tells us that we are reaching and making a difference to the lives of individuals at risk of social isolation, mental health crisis and homelessness.

Our project aims to reduce the negative impact on already fragile communities as much as possible and sends out a clear message that YOU are not alone and WE are all in this together.

If you need any help and support please contact Birchwood 01695 713248 or email: [email protected]

Link to our appeal

For further information on the coronavirus and how to keep safe and healthy;

www.gov.uk/guidance/coronavirus-covid-19-information-for-the-public

www.mind.org.uk/information-support/coronavirus-and-your-wellbeing/