In the 'Message' box of the 'Self-Referral' form, please provide some details about yourself and the issues you are experiencing: 1. Your Date of Birth 2. The issue you need help with 3. How long you've had this issue 4. Your availability (dates, times) and the mode of appointment (face-to-face in Elgin, Telephone, Skype, WhatsApp, or other applications). 5. Any other information you feel important to enable me to better understand your situation and requirement.