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Self Referral Form

YorSexualHealth (YSH) runs a free and confidential counselling service for people living within North Yorkshire and York who wish to seek support around different aspects of sexual health.

Our counsellors are experienced professionals, both in counselling and sexual health and are members of recognised professional associations.

This service is provided from locations across North Yorkshire and York, and is available to anyone living in those areas, irrespective of whether they have been previously registered with the YorSexualHealth service.ย Please see ourย information on counselling servicesย for more details.ย 

Sexual Health Counselling Self Referral Form

Contact info

We would prefer to contact you by email. Please supply us with an email address in the box below if you consent to this

Male FemaleOther

Telephone No (preferred number)

Can we leave a voicemail?


Can we send you a text message?


Can we leave a voicemail?


What towns/geographical areas are you able to get to?

Please tick area of preference

(It may be possible to arrange counselling elsewhere in NY where travel and access are difficult for you?)







Do you consider yourself to have any special needs or disabilities?

If yes, please could you give brief details if possible?


If you have a strong prefence to see a male or female counsellor this can be arranged

Strong preference to see a male counsellor
(Available at Northallerton and Scarborough)


Strong preference to see a female counsellor
(Available at York and Harrogate)


If you have strong preference to see a male or female counsellor but are unable to get to the areas listed above, please could you provide further details

If possible, could you briefly state what your counselling issue is:

Thank you for taking the time to complete the online referral form. Once submitted you should receive a reply within 5 working days. For any queries, please telephone the YorSexualHealth Counselling Service booking line on: 01904 725444