Get Support.

Islamic counselling can help you address, process, and manage your mental health problems, questions, and worries. If you or someone you know is eligible for our services please fill out this form, and the following Equality Monitoring form, and a member of our team will contact you to discuss the next steps available to you.

If you are not sure about whether you can access our free Islamic counselling services please click here.


About This Form

This is our referral form. It allows us to collect all the information we need to make your access to Islamic counselling smooth and safe. All of the information you send us is stored safely on an encrypted server and can only be accessed by certified members of staff. We do not store any of your information longer than we legally have to, and we will never share it with any third party except, in certain circumstances, your GP. This is a safeguarding measure all counselling services legally have to take.

Find out more about what to expect and how we manage the referral process.

Please take your time filling out this form, and ensure all your details, especially your contact details, are correct. This helps us make sure we can get back to you quickly.


If you need help filling out this form or experience any issues please email us or reach out to one of our social media accounts.