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Online Referral Form

IMPORTANT INFORMATION TO CONSIDER BEFORE CONTINUING:​

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  • We are an independent charity and are not affiliated with the NHS.

  • Our current waiting time for appointments is approximately 16-18 weeks.

  • We are only able to offer counselling to clients resident in Fife.      

  • Unfortunately our service does not have the flexibility to offer counselling to those who work a shift pattern or are not able to commit to the same day and time each week.        

  • The work of Talkmatters is supported by our volunteers and trustees and relies on donations and grants. It costs Talkmatters £49 to provide a single counselling session, but we ask you for £10 per session.If cost is an issue for you, please speak to us, as we may be able to source funds to cover the cost of your counselling. 

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REGRETTABLY, WE ARE NOT A SERVICE FOR THOSE CURRENTLY IN CRISIS.

WE ALSO DO NOT PROVIDE A TELEPHONE HELPLINE/LISTENING SERVICE.

IF YOU ARE IN CRISIS PLEASE CONTACT YOUR GP, OR CALL BREATHING SPACE ON 0800 82 85 87.

 


WHAT HAPPENS ONCE I SUBMIT MY REFERRAL FORM?

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  • Once your form has been submitted you will be redirected to a submission confirmation page.

    You will be contacted as soon as as an initial assessment appointment becomes available. As you will appreciate, we do have a waiting list and can therefore only give you 24 hours to respond to an offer of appointment, after which time the appointment will be offered to the next person on the list. We will keep you on our list until we have successfully offered you an appointment, received your request to be removed, or if we do not have a response from you by the given deadline.

  • Please note that if you indicate you do not wish to be seen by a counsellor in training, or you have limited availability, you may wait longer for an appointment. You will be offered a face to face or telephone appointment (face to face appointments will take place at our premises in Dunfermline).

  • If you are offered sessions after your initial appointment, these will be face to face by default.

  • If you require remote counselling (by telephone or video call) due to disability, or for another reason, please advise this in the disability arrangements section of the referral form below.

  • You must consider whether you are able to commit to up to 12 consecutive, unbroken weeks of counselling if you are offered counselling sessions after assessment. When you contract with us you are agreeing that you can come along every week unless there are extenuating circumstances (such as a holiday or medical appointment that is already booked). We will offer up to two pre-arranged breaks over the course of your counselling for any holidays or appointments you may have.
     

Referral Form

Data Protection

Information from this referral form may be processed for the purposes registered by Talk Matters under the General Data Protection Regulation ((EU) 2016/679)) (GDPR). Please refer to the 'Your Data and What We Do With it' section of this website here for further information on how we will process your data. PLEASE NOTE: We are not able to accept referrals from friends or family members. If you are a medical professional or working in a professional role and are referring on behalf of someone else, please give the name of person making the referral and their organisation in the box below.

I making this referral:
For myself
On behalf of someone else

GDPR Declaration

Please click here to view information on how we process your data: YOUR DATA AND WHAT WE DO WITH IT.


I am referring myself to Talk Matters and I can confirm I have read and understand the information provided in the 'Your Data and What We Do With it' section of this website. I hereby give my consent to Talk Matters processing the data supplied.
Yes
No
Not applicable
I can confirm that if this referral is being made on behalf of someone else, the person has given their informed consent for Talk Matters to process the data supplied in this referral form for the purpose of addition to the Talk Matters waiting list.
Yes
No
Not applicable

About You

Have you already received counselling with Talk Matters in the past year?
Yes
No

If yes, please note that we will still be able to add you to our waiting list, but are unfortunately unable to offer further counselling until 12 months have passed from the date you last ended sessions, due to the unprecedented demand for our service.

Title
Birthday
Gender

PLEASE NOTE that our appointment system is NOT automated; we must be able to contact you by AT LEAST ONE METHOD of communication in order to offer you appointments.

Are you currently waiting to be seen by a psychologist or another mental health professional?
Yes
No
Do you consider yourself to have a mental or physical disability?
Yes
No

Please note for telephone/video call counselling:

• You must have a safe place at home where you can receive a call in confidence.

• You must have a reasonable expectation that during the session you will not be interrupted.

• You must have time set aside to take the call at the same time & on the same day each week.

Do you experience any of the following? Please tick all that apply. If none of the options apply, please leave blank.

Contact Preferences

As previously noted, our appointment system is NOT automated; we must be able to leave a message for you by AT LEAST ONE METHOD of communication in order to offer you appointments. Please note if you do not agree to any means of contact at all, we will be unable to add you to our waiting list or offer an appointment.

Please indicate if any of the following apply:

Your Availability

Please note that it may take longer for us to offer you an appointment if your availability is restricted. As noted above, unfortunately our service does not have the flexibility to offer counselling to those who work a shift pattern or are not able to commit to the same day and time each week.


We offer counselling from Mondays to Thursdays, between the hours of 9.45am to 8.45pm (our last session each day begins at 7.45pm). You will be contacted with the next free initial appointment we are able to offer.


Please note that if you are unable to attend the appointment originally offered to you, we are only able to offer one attempt to reschedule.

We unfortunately do not have the flexibility to offer any further appointments beyond this.

Please indicate which days you will be able to attend by using the tick boxes below:

Session Options

We are a training organisation and counselling may be provided by counsellors in training.Please note that if you indicate you do not wish to be seen by a counsellor in training,you may wait longer for an appointment.Please indicate your preference below.
I agree to my counselling being provided by a counsellor in training.
I would like to be provided with more information about this before making a decision.
For face to face initial appointments, our therapy dog may be on the premises or in the counselling room during your session. Please confirm if you agree to this.
Yes, I agree to the Talk Matters therapy dog being in the room during my session.
No, I do not agree to the Talk Matters therapy dog being in the room during my session.
To your knowledge, is anyone in your family or friend group currently on our waiting list, being seen for counselling at Talkmatters, or working for Talkmatters?
Yes
No
How did you hear about us?
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