Therapy Self-Referral for Young Black Adults aged 18-25 years old from the UK
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  • Do you meet the above criteria? (From the black community, aged 18-25 years old (able to provide proof), UK resident and able to commit to weekly online therapy sessions)*
  • Title*
  • Gender*
  • Are you able to provide proof of age*
  • Ethnicity*
  • Employment status*
  • Where are you based in the UK? Please select area and know specific area in the other section.*
  • Are you happy for the therapy sessions to take place online?*
  • Have you been diagnosed with a mental health condition, if 'yes' please select and explain in the 'more info' section?*
  • Are you on medication? If 'yes' please select and explain in the 'more info' section?*
  • Have you had therapy before?*
  • Issues you would like support with? Select which issues you need support with and if not listed please specify in other section.*
  • Therapist preference?*
  • What is the best way to contact you?*
  • Would you also be interested in our online/in-person support groups?*
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  • Should be Empty: