Health Professional Referral
For Bereavement and Loss Counselling

CCIWBS is not a crisis service.
If the person you are referring is in crisis, please call one of the numbers below based on your area.

Camden & Islington
Crisis Team Tel: 020 3317 6333
Camden GP Hub Tel: 020 7391 9979
Islington GP Hub Tel: 0203 859 4959

or assist them to call Samaritans on 116 123 or visit their local A&E department.
Please provide as much information as possible so we can process your referral efficiently. If you are unsure if our service is the right service for your client or if you have any problems completing this online form, you can call us to discuss this.
Please Note: We can only take referrals for people over 18.

Fields marked with * are required

Referrer Details

Client Details

ESSENTIAL; Referral cannot be accepted without this

GP Details

We receive limited, annual funding for clients in the boroughs of Camden and Islington. Please note that if your client is not in these boroughs or the waiting list has been closed, clients can still access our service via our low-cost counselling service.

Details of Bereavement/Loss

Further Details

Please note we do not work with interpreters in counselling sessions. We do have some capacity to offer counselling in other languages. Please give details of your clients preferred language:

Referral Reason

Submitting this information confirms that you have consent from your client to share their details with us, and for us to store it electronically.