Self Referral Form

Our service is available to anyone between 13-25 years of age living, going to school or working in St Albans and District (ie including Harpenden, Wheathampstead, Redbourn, London Colney, Park Street, Colney Heath etc).
Please note that our service is self-referral only. As such, in order for us to set up an initial appointment this form MUST be completed by the young person themself.

Personal Details

Permission to Contact

GP Details

Further Details

In order to provide our service we need to hold some details about you. Information about our data policy is available on our website and it is important you understand this. By submitting this form you are agreeing to Youth Talk holding your information and our data policy.