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.

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.

Alternatively if you prefer you can call us on 01384 211 168 to request a form, and we can post it out to you, or we will be happy to complete the referral form over the phone on your behalf, with your or the clients consent. 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:

Any questions please do not hesitate to ask us and we will be more than happy to help you.

Be assured all your information is protected and will be held in the strictest confidence. Please read our disclaimer and privacy & Data Protection policy.

We will aim to respond to you within two working days of receiving your referral form.

Choose a form by clicking on the images below

The AOC Individual Therapy Referral Form

Two ladies sitting down talking.
Download individual referral form

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

Download family referral form

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

Download group referral form

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.