BOOK A CALL with an AUK advisor 

24/7 Self-care infoline: 03444 775 774

Search

Helping your Child referral form

  • This field is hidden when viewing the form
  • Please enter a number from 5 to 12.
  • Your details

  • Please note: we need details (name and number) for an emergency contact so we and your therapist know who to call in the event they need to at any time.
  • Your GP details

    Important: Neither your therapist nor Anxiety UK will usually need to contact your GP. However; as your welfare is of paramount importance, if issues of safety arise (for example, if either Anxiety UK or your therapist believes that you are a risk to yourself or to others) he or she may need to contact your GP before commencing treatment, or as appropriate during treatment.

    Your therapist will always discuss this with you before making contact with your GP. Therefore, it is essential we have your GP contact details as, without these, we cannot process your application.
  • Please note, if you are under 16 years of age we will require a letter from your GP giving their permission for us to provide access to treatment, as well as confirmation from your parent/guardian of their consent for you to access this service.
  • Providing an email contact for your GP is not essential, but may speed up the process should we need to contact them prior to you starting therapy.
  • Your child's health

  • 1 = fleeting thoughts of not wanting to be here; 10 = I have a plan and the will to carry out my thoughts.
  • Data Security

    If you have requested that Anxiety UK correspond with you by e-mail, which will require e-mailing your personal data outside of our own IT network. We are required to inform you there is the risk of data loss when e-mailing outside our IT network, therefore we require written confirmation (this can be an e-mail response sent to membership@anxietyuk.org.uk) that you accept this risk.
    We are happy to accept encrypted emails and documents. You can then call to provide the password over the phone. If you would like details on how to encrypt this document please contact services@anxietyuk.org.uk and the details will be passed over to you.

    Terms and conditions are available here or via the above email address.

Help others by providing advice and support to those in need.