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Call: 0161 820 9229
Email: office@hsrpsychology.co.uk

Parent / carer referral

Please provide as much information as possible on this referral form, as it will help us to choose the most appropriate psychologist for the initial discussion.

If you would like to refer your child to our services then please complete the following form and we will be in touch. All of the information you provide will be kept confidential. By completing this form you confirm that you have parental responsibility for the child or young person you are referring.


Your name: *
Relationship to child/young person: *
Your email: *
Your address:
Your phone number: *
Location / Address: *
Name of child/young person:
Date of birth of child/young person: *
What are the main concerns regarding the child/young person? *
What do you want from our involvement? *
Does the child or young person have any existing diagnoses?
Please feel free to attach any relevant documentation or reports with this referral. If there is more than one document please attach as a zip file.

No file selected.

Please select any professionals who have been involved with the child or young person:




Thank you!

We maximise the wellbeing and potential of children and young people by providing immediate access to a broad range of clinical, educational and child psychology services.

Call: 0161 820 9229

Email: office@hsrpsychology.co.uk

Visit: 3-5 St John Street, Manchester, M3 4DN

HSR Psychology is an independently owned and controlled not-for-profit social enterprise we reinvest any profits we generate to further maximise the wellbeing and potential of children and young people.

Our supporters

Thanks to the organisations below that have helped us to maximise our social impact:

lloyds logo SSE logo Lottery logo PWC logo EY Foundation logo Social Enterprise logo

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