Refer Yourself

Use this form to arrange counselling for yourself.

The information that you give on this form is confidential. This means that we will not give out details that identify you to anyone outside Yorkshire MESMAC unless you have agreed for us to do so or if there is serious or urgent danger to you or anyone else. Please see our confidentiality statement for more information.

Remember, our counselling services are only available in Leeds, Bradford and Wakefield.

In case we are unable to contact you by telephone

Depending on counsellor availability in certain areas, we may not have a choice in this regard, but if we do we will always take your preference into consideration.

This is so that we know we are providing a full service across the whole of the West Yorkshire region covered by Yorkshire MESMAC.

We will contact you for more information and if we need to make any adjustments