Enquiry Form

Step 1 of 3

Tell us a little about yourself

Step 2 of 3

Your contact details

Step 3 of 3

Do you have any additional requirements?

E.g. language, cultural, mobility access, disability or any other needs

Derwent Rural Counselling Service is not an emergency service and if you are having thoughts that you cannot keep yourself safe please call your GP, 111 or 999 or report to your nearest A&E department.

On receipt of your referral we will contact you to discuss moving your referral forward as quickly as possible.