On-Site Counselling Referral

Request On-Site Counselling

Important Note:

If you believe there is an immediate risk to the employee or others, please contact emergency services by dialling 999.

Additionally, inform Wellbeing Solutions directly on 020 7708 5000 to expedite any necessary interventions.

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Request On-Site Counselling

Wellbeing Solutions offers a range of counselling referral options to help your employees navigate personal and professional challenges. This referral form enables HR professionals to arrange on-site counselling services.


How It Works:

  1. Complete and submit this referral form with all required information.
  2. Wellbeing Solutions will contact you if needed to discuss date requirements.

Key Points to Note:

  1. On-Site counselling is best utilised on an ongoing basis (either short-term or long-term) to ensure individuals can benefit from consistent, planned support.
  2. You should ensure that there is a quiet, private and comfortable room available.
  3. Any rota/booking schedule will need to be managed and arranged internally.

For urgent queries, contact Wellbeing Solutions at 020 7708 5000 or email customerservices@wsm-wellbeing.co.uk.

Your Organisation and Referrer Information

Please provide your organisation’s details and the contact information of the person submitting this referral. This ensures we can process the request efficiently and reach out if further clarification is needed.



Authorisation

Please provide the details of the manager authorising this referral. This ensures the request is formally approved within your organisation.

Referral details

Please provide the following information about your request. This will allow us to coordinate the counselling sessions effectively. All details will be handled in strict confidence, in accordance with GDPR and Wellbeing Solutions' data protection policies.

Risk and Safeguarding Details

Please complete this section to highlight any known risks or safeguarding concerns. This information helps us deliver safe and appropriate support for the employee. If no risks are known, mark "No" in the relevant sections.

Important Note:

If you believe there is an immediate risk to the employee or others, please contact emergency services by dialling 999. Additionally, inform Wellbeing Solutions directly on 020 7708 5000 to expedite any necessary interventions.

Select referral type and counselling options

Please select the length of time you would like the counsellor to be on-site and specify the number of sessions you would like to book.

Billing and Invoice Details

Please complete the following details for invoicing. Invoices will be issued separately from your organisation’s EAP subscription for sessions delivered.

Terms and Conditions for On-Site Counselling Referral Services

  1. Commitment upon submission:
    By submitting this referral form, the authorising manager confirms approval for Wellbeing Solutions to arrange additional counselling sessions as specified. This referral constitutes a binding contractual agreement.
  2. Service confirmation and delivery:
    Wellbeing Solutions will contact the employee directly to arrange counselling sessions based on the selections made in this form. Sessions will be delivered by qualified clinicians in line with Wellbeing Solutions’ clinical governance standards and the BACP Code of Ethics.
  3. Confidentiality:
    The employee’s identity, previously confidential under the EAP self-referral process, has been voluntarily disclosed for the purposes of this referral. All personal and session details will remain confidential and managed in line with GDPR and the Data Protection Act 2018.
  4. Cancellation policy:
    • Three or more working days’ notice: 50% of the agreed fee will be charged.
    • Anything less than three working days: 100% of the agreed fee will be charged.
    • Rescheduling requests made with less than three working days’ notice will incur a £50 administrative fee in addition to the standard cancellation fees.
  5. Payment terms:
    • You will be invoiced for all billable sessions outlined above upon receipt of this order.
    • Invoices are due within 30 days of issuance.
    • Late payments may incur interest at 4% above the Bank of England base rate, calculated daily from the due date.
  6. Safeguarding:
    Any risk or safeguarding concerns disclosed within this form will be managed in line with Wellbeing Solutions’ safeguarding policy. For immediate concerns, please contact emergency services by dialling 999.
  7. Liability:
    Wellbeing Solutions shall not be liable for indirect or consequential loss arising from the delivery of services, including delays caused by circumstances beyond reasonable control.
  8. Clinical governance:
    Counselling sessions will be provided by clinicians adhering to Wellbeing Solutions' clinical governance standards and the BACP Code of Ethics.
  9. Amendments to This Agreement:
    Any changes to this referral must be requested in writing and confirmed by Wellbeing Solutions prior to implementation.

Acknowledgment and agreement:
By checking the box below, I confirm that I have read, understood, and agree to the terms and conditions outlined above.

Authorisation and Submission

By completing the fields below and clicking "Submit," you confirm your request for additional counselling sessions as outlined in this referral form. Upon submission:

  • An Adobe-signed PDF will be generated and emailed to the contact email address provided.
  • A copy will also be sent to Wellbeing Solutions to initiate the order process.
  • A member of our team will contact you shortly to finalise details and confirm the booking.

If you have any questions during or after submission, please email us at customerservices@wsm-wellbeing.co.uk or call 020 7708 5000