My College @ The City of Liverpool College

Mental Health Support Referral Form

  1. Please complete this confidential form.

    Your contact details will be sent to Dee Fearnhead, the college's Counselling and Wellbeing Manager. Dee will call you directly to arrange an assessment of your needs.

    If you are a tutor referring a student via this form, please ensure that the student is in agreement to you passing this information on.

Your Details
  1. (required)
Contact Details
  1. (valid email required)
  2. How would you prefer to be contacted?
Preferred Centre
  1. (required)
Special Requirements
  1. I will call you to arrange an assessment of your support needs.

    If you are a tutor filling in the form on behalf of one of your students, I will let you know if I am unable to make contact with them directly. This is to ensure that "at risk" students do not fall through the net.

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