Referral Forms

At Trust House Lancashire, we accept self-referrals and referrals from all agencies.


We offer the following services

  • Counselling
  • Well-being Support
  • Family Support
  • CYP Counselling
  • Play Therapy


All our staff and volunteers undergo a specialist training programme in order to work at Trust House.


We offer a person centred service meaning we are guided by the client; pacing ourselves to accommodate the client’s comfort level and emotional needs.


Please download our referral forms by selecting the appropriate button below.

Important Notice – children and young people referrals

Our current waiting time for children and young people is at least 12 months from the point of their referral being accepted. Before submitting a referral for these clients, please inform the young person and/or their families of this, to help manage their expectations.

 Children, Young People’s & Family Referral Form 

Referral Form for Adult Services

Self-Referral Form (18+)

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