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Helping young people find their voice

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Please note that our service is self-referral only. As such, for us to set up an initial appointment this form MUST be completed by the young person themselves with their direct contact details where available. We need the consent of the young person in order to offer counselling sessions.

If you prefer, we can fill in your form with you over the phone. Please phone us on 01923 239495 or 07444 768078 or you can email us at [email protected]
The office is open Monday to Friday, and we will get back to you as soon as possible after your initial contact

Please note, as a counselling charity, we are not a crisis service. If you need immediate help to keep yourself or others safe, please call NHS 111 and press option 2,. You can also contact your GP or go to your local Accident and Emergency department. If you feel yourself or others are at
imminent risk of physical harm, please call 999.

You can also contact any of the below services:
Single Point of Access (SPA) on 0300 777 0707 or 0800 644 4101. This is a 24/7 service.

Text SHOUT to 85258 (All texts are answered by trained volunteers. Texts are free from EE, O2, Vodafone, 3, Virgin mobile, BT mobile, GifGaff, Tesco mobile and Telecom Plus)

Samaritans.org – call from any phone anytime for free 116 123

Childline 0800 1111

    Application form for new clients

    This form should be filled in by the person who requires counselling. If you prefer we can fill in your form with you over the phone. Please phone us on 01923 239495 or 07444 768078

    If you feel your needs are high and you require an emergency assessment please contact us on one of the numbers above. Please be aware that Signpost does not currently have staff to answer your calls or emails on Fridays, Saturdays and Sundays. We will get back to you as soon as we receive your contact details and no later than 72 hours/3 days.

    If you require immediate help please contact the following services below or seek advice from your GP. If these are not options for you (it is a weekend and you can’t see your GP) go straight to A&E at your local hospital where you can be seen by the assessment team.

    We want everyone who comes to us for support to feel confident and comfortable with how any personal information you share with us will be looked after. Our Privacy Statement sets out how we collect, use and store your personal information (this means any information that identifies or could identify you).

    * Required

    FemaleMaleRefused|Prefer not to say
    EmailMobileText

    WatfordHemel HempsteadBorehamwoodVideo counsellingTelephone counselling

    Morning 10-1Afternoon 1-4Evening 4-7

    Monday Monday Morning Monday Afternoon Monday Evening
    Tuesday Tuesday Morning Tuesday Afternoon Tuesday Evening
    Wednesday Wednesday Morning Wednesday Afternoon Wednesday Evening
    Thursday Thursday Morning Thursday Afternoon Thursday Evening
    Friday Friday Morning Friday Afternoon Friday Evening
    Saturday Saturday Morning Saturday Afternoon Saturday Evening
    FemaleMaleDon't mind
    Family|Family or FriendGPSchoolCAMHSReferred by other professionalYouthriveOther

    Application form for new clients

    * Required

    Assessment and Issues

    Please mark all boxes which apply

    Abuse (emotional)Abuse (physical)Abuse (sexual)AddictionAnger/AggressionAnxietyASDADHDBereavementBullyingBehaviour problemsDepressionDrug or alcohol problemsEating disorderEducationFamily issuesFriendships/peer problemsGender identityMental Health issue (if not listed)Obsessional Compulsive Disorder (OCD)Panic attacksPersonality/Mood DisorderPhobiasRelationshipSelf esteem/confidenceSelf harmSexual identitySexual health/pregnancyStressSuicidal thinking/plansTraumaTrustWork/careerOther
    CounsellingCoachingDon't know|Don't know (we can talk with you about this on the number shown at the top of this form)
    YesNo

    Application form for new clients

    * Required

    Monitoring

    All data will be stored responsibly and according to GDPR legislation and only for its intended purpose.

    NoneMobilityVisual ImpairmentHearing ImpairmentProgressive/ Chronic IllnessMental HealthLearning DisabilityAutistic Spectrum ConditionOther (disability type)
    Mother and FatherMother/Father onlyMother/Father and Step-ParentFoster parent(s)Adoptive Parent(s)PartnerLiving aloneOther
    BuddhistChristian (all denominations)HinduJewishMuslimSikhAtheistNoneDo not wish to discloseAny other religion