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SELF-REFERRAL

Birthday
Day
Month
Year
Multi-line address
How would you like to be contacted?
Are you currently receiving support from a psychiatrist, psychologist or counsellor ?
Yes
No
Previously had support
Any medication for mental health?
Yes
No
What Hub services are of interest?
When are you available? (tick all that apply)

Counselling Session Contributions

The MHWH is charitable incorporated company run by volunteers and counsellors . For the next 12 months we are funded by Platform housing , The National Lottery, Malvern Town Council ,MHDC and the CO OP with rooms donated by Malvern Football club . The client contribution is not only an investment in yourself and your future , but allows us to keep supporting the community and keep the hub open . We appreciate times are hard at the moment , but we are doing our very best to keep costs to a minimum and still be able to keep running . The requested client contributions are set at the very minimum to comply with our grant funding . Thanks for your support and understanding .

A £10 contribution for the first session/assessment paid in advance to your allocated Counsellor is required .

Contribution options
Would like to apply for concession
Would like to apply for a concession to reduce client contributions after the initial session ( form will be sent out requesting further information )
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