Get in touch

Thank you for reaching out. Whether you're looking for support for yourself, referring someone else, or enquiring on behalf of an organisation, we'd love to hear from you. Please complete the form below and we'll be in touch as soon as we can.

Important notice

This therapy service is for Anyone connected to Chesterfield FC Community Trust or Chesterfield FC, including players, staff, volunteers, supporters, and those referred by CFCCT or partner services.

Please don't use this form if you need urgent support. If you or someone else is at immediate risk, call 999. For urgent mental health support, or contact NHS 111 (Option 2)

1 - This enquiry is...

For myself

For someone else

I'm making a professional referral

2 - You contact details

Please enter your own contact details, whether you're seeking support for yourself or referring someone else. After completing this section, if you're not referring anyone, you can skip Section 3.

First Name

Last Name

Phone Number

Email Address (optional)

3 - Are you referring someone else?

Only complete this section if you're referring someone else. Otherwise, you can leave it blank.

First Name

Last Name

Phone Number

Email Address

4 - What would you like support with?Anxiety

Addiction

Anxiety / worry

Low mood / stress

loss / bereavement

Trauma / PTSD

relationships

loneliness / isolation

parenting

work / career

confidence

I'm not sure yet

Other

On a scale of 1-10, how are things feeling at the moment?

0* I'm coping well 10* I'm really struggling

Is there anything else you'd like us to know? (Optional)