Counselling referral

To make a self-referral to our counselling service, just fill out the form below.Your request will be processed the following business day.

For urgent or emergency requests please call 0508 664 981

Please be assured that the information you give is confidential to Vitae.

Referral form

 Work related
 Personal
 Combination work/personal
 Yes
 No
 Yes
 No
 Yes
 No
 Urgent
 1 - 2 days
 3 - 5 days
 Yes
 No