Self-Referral Form

Our Digital team (excluding the East Midlands) is currently closed for referrals. If you need help please contact us on live chat or email gethelp@akt.org.uk.

PLEASE NOTE if you are a professional or an ally who is referring a young person, you will need to complete our External Referral form
Contact Details









About You

Please write as dd/mm/yyyy













If you have had a condition for more than 12 months.








Further Information