An image of someones hands

Counselling Referral form

The Bridge Counselling Service is open to men and women aged 14 years and over, living in the Avon and Somerset area, and who have been raped, sexually assaulted or sexually abused either recently or historically.


In order to be eligible for counselling at The Bridge it is important that you are not already attending sessions with a counsellor; do not have significant current or recent drug or alcohol addiction and are not either sectioned under the Mental Health Act or have severe and enduring mental health problems.


About you






 

About your GP

Referred by (if applicable)

About the abuse or assault

About your visit





Verification

A verification image

Please enter the word you can see in the image to the left, alternatively you can have the word read out.


Back to top Privacy Statement