STEPS - self referral form | Stroke Association

STEPS is a stroke-specific emotional-support counselling service for stroke survivors, carers and relatives who live in Northern Ireland. The service provides free, professional, one-to-one counselling - in person, by telephone or online. Find out more about STEPS.

If you are a stroke survivor or care for someone who is, you can access this service by filling out our online form below. For more information, please see our Frequently Asked Questions.

Please note - we are currently recruiting the new counselling team for STEPS, which we hope will be in place in late autumn 2021. Any referrals received will be placed on a waiting list and contacted when the new team is in place.

Your details

Name

Date of birth

Email address

Telephone number

Can we leave a message?

Yes

Can we send a text?

Yes

Address

Address line 2

City/Town

Postal Code

Name of GP

Name of GP Practice

GP telephone number

Date of stroke

Please tell us briefly how counselling might be able to help you. Please see our FAQs for details on what is/is not considered an appropriate referral.

Please tell us about any support you are currently receiving from your GP, community mental health, clinical psychology, community stroke team or other.

Additional needs

Do you have aphasia?

Yes

Any other additional needs?

How would you like to hear from us?

By email

By phone

By SMS

Your privacy is our priority. We promise to keep your details safe and will never sell them. We will also keep in touch by post about how we can continue to support you, and opportunities to support us. If you would like to change the way you hear from us, just call 0300 3300 740 or email supporter.relations@stroke.org.uk. How we protect and use your personal data is set out in our privacy policy.

STEPS - self referral form

Your details

Additional needs

Consent to staying in touch