Self-referral

Tell us about you or a loved one you want to help

DRCS 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

If you prefer to talk to us, please call us on 0800 047 6861

Working in partnership with

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    Tell us a little about yourself

    Your Name

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    Step 2 of 5

    What is your address?

    Your Address

    Your Postcode

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    Step 3 of 5

    What is your date of birth and email address?

    Date of birth

    Your Email address

    Your Phone number

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    Step 4 of 5

    Your gender

    Gender

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    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.

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