If you would like to request:
please contact us at firstname.lastname@example.org or complete the form below.
Based on your individual situation (e.g. your locality, type of therapy preferred) you will be offered two or three names of therapists you can contact. Please complete the form as far as you can to help us to make an appropriate match for you.
This form can also help with selecting a supervisor.
If you would rather complete a printed form you can download our Referral Request Form (pdf) and post it to:
1174 Stratford Road
Birmingham B28 8QA