Counselling student self referral questionnaire

This form is for Lancaster University students only

Do you want to complete a new form or load an incomplete one?

The self referral form really helps us to determine the best way we can support you. The form is quick and simple to complete. However if you have any concerns or difficulties with the form itself please do not hesitate to contact us.

Enter your University Email below (we only use official University email):

Please enter the unique code contained in the email sent to you: