Counselling and support for
children and young people
Call TeenTalk on
01225 667328

Make a Referral

We are sorry, but the unprecedented level of referals to our service recently means that we have temporarily had to close to new referrals while we give support to young people already on our system.

We will be reopening for new referrals as soon as we have cleared the backlog - please watch this space!

If you think your child would benefit from our TeenTalk Counselling Service please complete this referral form.

Once submitted, one of our team will be in touch in the next few days to discuss your concerns. They will need to speak with your child and will confirm if we are able to offer appropriate support.

Service Referral Form

Referrer's Details

Please complete this section telling us who is making the referral. You will be asked about the young person in the section below. We cannot accept the referral if this section is not completed.

Young Person's Details

Please complete the section below giving information about the young person you are referring. It is essential that you have the consent of the young person to refer them to us.

The Legal Bit

In order to retain and use your contact details under GDPR regulations we have to ask your permission to contact you back. Please tick the relevant boxes below. Remember, if you don't say we can contact you using a method we can't do it!

Please enter the phone number that we should use to call you to arrange your appointments. This can be a parent/carer's telephone but when we first call we will need to speak to the young person to undertake an initial assessment over the phone. By entering your number here you are expressly giving us consent to call you for the purposes of arranging services from TeenTalk.
Please be assured that we will never pass on your details to anyone else. They will only be used so that our Early Help and Support Team can contact you about your referral and any appointments for you to meet with us.
By submitting this referral form you are consenting to TeenTalk (Young Melksham) retaining and storing the information supplied as set out in our Privacy Policy. All information supplied is held in strict confidence and access to it is restricted only to those who require access in order to carry out their duties at Young Melksham.
We are able to deliver our services thanks, in part, to the generous support of these organisations
Big Lottery FundWiltshire Community FoundationMelksham Without Parish CouncilMelksham Town Council
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TeenTalk is a service provided by 4Youth (South West). 
4Youth (South West) is a company registered in England and Wales, Company Number 7871666.
Registered Office: The Canberra Centre, 56a Spa Road, Melksham SN12 7NY
Charity Registration Number: 1147394
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