Referral Forms

The AOC have three different referral forms:

  1. for personal, individual or couple therapy;
  2. for families; and
  3. for anyone wanting to receive group therapy.

All forms may be completed by any UK adult (18 years old or over) only or someone of the same age or over completing on behalf of a person, couple, group or family requiring therapeutic intervention. Alternatively if you prefer you can call us and we will be happy to complete the referral form on your behalf. Call us on 07582 643371.

This person may be a friend, family member or professional and must have the agreement of the person, group or family that they can complete the referral form on their behalf. Please be sure to state you have their permission on the referral.
Any questions please do not hesitate to ask us and we will be more than happy to help you.

Be assured this form and all your information is protected. Please read our disclaimer and privacy policy.

Choose a form by clicking on the images below


The AOC Individual Therapy Referral Form

Individual therapy session

If for yourself, a couple or on behalf of another person. For anyone aged minimum 5 years, young person or adult but cannot be completed by anyone under 18 years.

The AOC Family Therapy Referral Form

Child participating in family therapy session

If for a family who include any person aged minimum 5 years, young person or adults with no upper age limit but cannot be completed by anyone under 18 years.

The AOC Group Therapy Referral Form

The AOC's group therapy session

If you are an adult aged 18+ and wish to either join a therapy group or have a therapy group set up at your place of work. Cannot be completed by anyone under 18 years.


Your information will be held in  strictest confidence and we will aim to respond to you once we receive your referral form within two working days.

Alternatively you can request any form by calling us on 0333 772 9636 or 07568 568131 and we can post it out to you. Please be clear which form you are requesting: individual, family or group.

You can either return your referral form back to us securely by post (our address is on the form or you can find it at the bottom of this page) in person, or you can scan them and email back to us if you prefer to at:

support@theaoc.org.uk