Completing our Referral Form

To navigate between the tabs, click on next or previous, if you need to go back.

There are eight mandatory fields which will need to be completed before the system will allow you to progress to the next page. They are:

• Forename
• Surname
• Contact Number
• Address (including postcode)
• Details
• My Issues
• GP Details
• Referrer Details.

If you are under 16 or a parent or referrer completing on behalf of an under 16 year old, you will be asked to provide Parent/Guardian Name and Contact Number.

Email, date of birth, gender, or school (for under 16) are optional, but very helpful for us to know.

Location

If you require counselling in a particular location this may mean a longer wait, please also be aware that not all locations are available every day.

Broadway House – Every weekday

Thatcham Hub – Wednesday & Thursday Evening

Lambourn Surgery – Monday and Tuesday Early Evening

Hungerford Surgery – Thursday Early Evening

Details

This is a text box and your opportunity to let us know why you are looking for counselling now, including any relevant medical/family history. What do you feel might be significant to share with us at this point? Could you also let us know your likely availability so we can take this into consideration?

Consents

In order to provide an effective and professional counselling service, Time to Talk holds information about you, which includes contact details, information about your GP, date of birth, source of referral, previous experience of counselling and medication used and a brief session note. Your personal data will not be shared with anyone outside Time to Talk without your knowledge and permission, unless any of the following apply:

1. When a counsellor has good grounds for believing that a person may cause serious harm to themselves or others.
2. When we are instructed by a court to disclose information.
3. When a person discloses serious criminal activity, or knowledge of serious criminal activity, this includes statutory obligations in relation to terrorist activity and is a legal requirement.
4. When it is necessary to uphold child protection laws. Your personal data is usually held by Time to Talk for 6 years after you have finished counselling.

Time to Talk is accredited by the British Association for Counselling and Psychotherapy (BACP) and all our counsellors comply with the BACP’s Ethical Framework for the Counselling Professions.

In accordance with their professional requirements, counsellors discuss their work with an external supervisor, but the identity of the client is not revealed. Case material may sometimes be used anonymously by counsellors to enhance their practice and professional development.

Anonymised data is used for the purposes of accounting, fundraising, preparing annual reports, publicising Time to Talk’s work, raising awareness and research. Anonymised data is also shared with the NHS where you have given us permission to do so.  You can ask to see the information held about you at any time and a data subject access request will be responded to within 30 days of your request.