Self-Referral Form

NEECS aims to protect the confidentiality of clients at all times. By providing details on our self-referral form, we consider this as confirmation you agree to us using the details to provide you with the service requested. NEECS will only ever use your details for this purpose. NEECS staff comply with NEECS Confidentiality Requirements.

Before completing this form it is important to check your availability to attend matches NEECS appointment times. If you require any help completing the form please call us on 07498 520 377.

We are not able to say how long you will have to wait for an appointment, but be assured we will be in touch as soon as possible. We will be adding more appointment times when possible.

NEECS offers counselling during the folowing times........

  • Mondays:10.30pm only
  • Tuesdays: 11am, 12.30pm, 1.15pm and 5.30pm
  • Wednesdays: 9.30am to 2pm (last appointment)
  • Thursdays:To be confirmed
  • Fridays: 9.30am to 2pm (last appointment)

All counselling sessions will be at the same time, on the same day each week. 

For some further sources of help click the other sources of help link on the home page. Or contact us by email, using the Get in Touch link. 


All NEECS staff comply with NEECS Confidentiality and Privacy Requirements.