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PROFESSIONAL REFERRAL

Referrer's Details

Client Information

Birthday
Day
Month
Year
Multi-line address
What Hub services are of interest?
Are you currently receiving support form a psychiatrist, psychologist or counsellor ?
Yes
No
Have had previous support
Any current mental health related medication?
Yes
No
Unsure
What is there availability (tick all that apply)

Counselling Client Contributions

MHWH is charitable incorporated company run by volunteers and counsellors . We are funded for 12 months by Platform housing, The National Lottery, Malvern Town Councill ,MHDC and the CO OP with rooms provided by Malvern Town Football club . The client contribution is not only an investment in yourself and your future , but also allows us to continue to support the community . We understand that times are hard and so we have kept costs to the very minimum that we can . But to comply with our funders and to be able to deliver the service we ask for your support and investment into yourself and your community . A £10 contribution required to be paid in advance to your counsellor for the first session/assessment .

Client Contributions
Application for a concession
Would like to be contacted to apply for concessions to reduce contributions after the first session (a form to gather further information will be sent out to apply for concessions )
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