This is a self-referral form for Lancashire LGBT. This form is for those who are:
- aged 18 and over
- wanting to receive support via the counselling service
The information which you give in this form will be used in accordance with the General Data Protection Regulation and to enable Lancashire LGBT to compile statistics for our funders. We will not share any information that would identify you as an individual with anyone. The information will be kept securely, and will be kept no longer than necessary.
With all our referrals, we am to be in contact with you within 2 months. We are experiencing a high level of referrals at the moment so expect this period to be extended. We apologise and will be in touch as soon as possible. Your place on our waiting list is not impacted by this wait.
Please note, we are not an emergency service.
If you are seeking immediate support with your mental health please contact 111.