Self referral

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

Step 1 of 5

Tell us a little about yourself

Your Name

What is your address?

Your Address

Your Postcode

What is your date of birth and email address?

Date of birth

Your Email address

Your Phone number

Your gender

Gender

OtherFemaleMale

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.