Our form is for self-referrals and assisted self-referrals to help access the lowdown’s services only.

An assisted self-referral is when you have someone who is helping you to complete this form. The information you provide will enable us to offer the most appropriate services and actions. It will be kept confidential and securely stored and shared as appropriate within the lowdown.

NB: We are not able to offer you counselling / therapy if you are seeing another counsellor or psychological therapist, or if you are currently receiving a high level of Mental Health Care. In those cases, we might be able to offer another service.

Confidentiality is central to our work but it is not absolute – there are legitimate exceptional circumstances which require the lowdown to share information with others, such as; if a person is at risk of serious harm by others; if a person is at risk of serious harm to themselves, or to others; or there is a risk of serious crime. View our Confidentiality and Privacy policies (copies are available on request).

Some information will be used for reporting purposes; in these cases the data will contain no identifying information that could associate you with receiving a service. Any other information will not be released without your consent unless required by law or a court order as stated above.

ANY QUESTIONS? Prior to, during and after you have received a service, you can contact us via: with any questions.


WE OFFER BOTH FACE to FACE and REMOTE SUPPORT - meaning assistance will be given over the telephone or a video call. * Please note that young people under the age of 16 require parent / guardian consent to download the Zoom application onto personal devices.
Powered by NEX-Forms

“We understand that it can feel like a big step to take, but we are here for you. You are not alone…”

Skip to content