Here at No Limits, we have a wide range of services to support you with anything you’re facing.

Please complete the form below to tell us what you would like support with, and how we can get in touch with you. We will do our best to get in touch with you within 3 working days.

Please note that we will make 3 attempts to get in touch with you after receiving this form.

We cannot accept referrals for counselling services with this form.Instead, please call 023 8022 4224 option 3,to speak to a member of the Counselling Admin team or to book a Counselling Assessment (slots are released 12.00 on a Monday and 18.00 on a Wednesday but you can contact at any time to book).

Because we’re asking you for your name and contact information, we need your consent to hold that information. We hold this information in a secure database. Only No Limits staff with specific permissions have access to it, and we will not disclose it to anyone else without your consent. We do use it for statistical reporting to the organisations that fund us, but that does not contain any information that could be used to identify an individual person.

To find out how we use your data, click here.

  • Refer myself

Refer myself

I confirm that I am happy for you to hold my information.

Is your enquiry about counselling?

We are unable to proceed with counselling referrals via this form. Please call 02380 224 224 option 3 to speak to a member of the counselling admin team. If you need to refer to any additional services, please proceed with submitting this form, and contact the counselling admin team via the phone number above.

Your name

Your email address

Your phone number

When we contact you about this referral, can we identify ourselves as No Limits?

Please tell us anything else we need to know about getting in touch:

Your date of birth

Your postcode and/or town/city

Your gender

Your ethnicity

Please let us know what you would like help with:

Please tell us anything else you think we might need to know:

We cannot accept a referral without you giving us your consent for us to hold your information for a limited period of time. Please go back to the start of this form if you would like to change your mind.

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