WCTS
Self-Referral Form
We
encourage self referrals from women as well as from other helping
agencies. Enquiries can be made using either this email form or via
letter or phone. If we cannot provide what you are looking for we will
try to suggest another service which can.
The
service is available to women regardless of their ability to pay. We do
ask women who can do so to make a regular contribution, based on what
they can afford.
If having
read the information on our web site about the services we offer, you
would like to put your name on our waiting list for an assessment,
please fill in the relevant information on this form and click on the
submit button. If you are not happy with the information then please
press the Clear button to clear all the entries on the form.
To move
between each box use the tab key on your keyboard or click in each text
box using the mouse.
Please note: that the Women's Counselling and Therapy
Service is for women who pay their countil tax to, or who receive
council tax benefit from Leeds City Council in West
Yorkshire, UK. Unfortunately we cannot take referrals from women living
outside this area.
