Self-Referral Your Referral Disability or Injury? logo acf-forms activecampaign authorize aweber bootstrap campaignmonitor constant_contact getresponse googlesheets highrise hubspot mailchimp mailpoet paypal icon polylang salesforce salesforcealt stripe stripealt twilio woocommerce Zapier required delete move drag clear noclear duplicate copy clone tooltip tooltip_solid forbid checkmark image checkmark circle checkmark square check check1 plus plus1 plus2 plus3 plus4 minus minus1 minus2 minus3 minus4 cancel cancel1 close report_problem_solid report_problem arrowup arrowup1 arrowup2 arrowup3 arrowup4 arrowup5 arrowup5_solid arrowup7 arrowup6 arrowup8 arrowdown arrowdown1 arrowdown2 arrowdown3 arrowdown4 arrowdown5 arrowdown5_solid arrowdown7 arrowdown6 arrow_left arrow_right filter download upload2 download2 hard_drive pencil_solid pencil pencil-message signature register account_circle_solid account_circle address_card paragraph checkbox_unchecked checkbox checkbox_solid dropdown caret_square_down radio_unchecked scrubber location_solid location toggle_on toggle_off shield_check shield_check_solid clock clock_solid email_solid mail_bulk code tag tag_solid price_tags search sitemap file file_text_solid file_text option option_solid more_horiz more_vert more_horiz_solid more_vert_solid calculator key key Filled Key Icon keyboard eye eye_solid eye_slash_solid page_break view_day attach_file printer header h1 repeat repeater save sliders code_commit star star_full star_half star_feedback linear_scale pie_chart stats_bars sms feed align_right align_left button browser cloud_upload_solid shuffle swap pallet fingerprint ghost heart_solid heart history import export label_solid label lock_open lock alt_lock dollar_sign percent notification external_link pageview_solid pageview settings stamp support text white_label building icontact sendinblue sendy wordpress credit_card credit_card_alt cc_amex cc_discover cc_mastercard cc_visa cc_paypal icon cc_stripe price product total quantity directory Preview Autism Brittle Bones Brain Injury BSL Counselling England BSL Counselling Wales & Scotland BSL Counselling Ireland CODA Ehlers-Danlos Syndrome Endometriosis Cerebral Palsy Hearing Loss Muscular Dystrophy Continued Limb Loss Lumber Spondylosis Multiple Sclerosis Rare Genetic Disorders Road Traffic Accident Skeletal Dysplasia Spina Bifida Spinal Cord Injury Sight Loss Carer Not Listed Disability Brief explanation about your disability or injury. The NHS ASD DisabilityPlus are not able to apply for Free Funding. Visit your General Practice, they can refer you to specialist NHS Funded ASD service . The NHS BSL DisabilityPlus are not able to apply for Free Funding in Ireland. Please visit your GP for mental health counselling. The NHS BSL DisabilityPlus are not able to apply for Free Funding in England. SignHealth have a national contract with NHS England. Their website:https://signhealth.org.uk/with-deaf-people/psychological-therapy/ Road Traffic Accidents DisabilityPlus are not able to apply for Free Funding if you have NOT obtained a disability through the accident. Carer Counselling DisabilityPlus are not able to apply for Free Funding for Carers CODA Counselling DisabilityPlus are not able to apply for Free Funding for people who are CODA. Hearing Loss Counselling DisabilityPlus are not able to apply for Free Funding for people with Hearing Loss outside of Wales. Topics Counselling For? Adjustment Disorder Abelism Anxiety Autism Chronic Pain Chronic Fatigue Depression Grief & Loss Eating Problems Low Self-Esteem Life Changes Mood Swings Trauma Social Anxiety Other Address & Contact Your Name? PostCode? Date of Birth 00/00/0000 Phone Number? Email * Gender? Summary Why would you like support? Preferred * Assessment Session for Free Funding Self-Paid & Assessment Session (Free Funding) Self-Paid only Employment Support Other Submit If you are human, leave this field blank. Self-Referral Form Your Referral Referral Topic Ataxia Autism Brain Injury Deaf Cerebral Palsy CODA Limb Loss Muscular Dystrophy MS Spina Bifida Spinal Cord Injury Other ASD NHS Funded ASD NHS Funded DisabilityPlus are not able to apply for Free Funding. Visit your General Practice, they can refer you to specialist NHS Funded ASD service . Therapy Topics? Topic? Adjustment Disorders Anxiety Chronic Pain Depression Chronic Fatigue Eating Problems Low Self-Esteem Life Changes Mood Swings PTSD Social Anxiety Other Address & Contact Your name? Postcode? Date of birth 00/00/0000 Phone number? Email * Your gender? What you would like to be referred to as? Anything to add? Reason for Referral Preferred Referral * Assessment Session for Free Funding Self-Paid & Free Funding Application Self-Paid Only Employment Support Other Submit If you are human, leave this field blank.
