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Use this form to refer yourself or a young person into our service
In this form we ask for some personal information, including contact details and information relating to personal history etc. in order to fulfil your request for service with us.
Any processing will be performed in line with the Data Protection Act 1998 and the General Data Protection Regulations.
Our registration number with the Information Commissioner’s Office is ZA361968. Please read the privacy notice for counselling and support services to ensure you understand how we process personal data.
LINK to privacy notice