MSL Counselling Referral

For managers, staff, and dependants with an active MSL code who would like to request confidential counselling with a qualified therapist.

Important – What MSL Counselling Does Not Cover

MSL is not an emergency, crisis, or medical service. We cannot provide:

Immediate crisis intervention or emergency mental-health support
Support where there is serious current risk of harm to yourself or others
Assessment for medication, fit notes, or formal medico-legal reports
Safeguarding investigations, HR decisions, or occupational health assessments

If you are in crisis or feel at immediate risk, please contact your GP, NHS 111, your local Crisis Team, or emergency services on 999. You can also call Samaritans free on 116 123. Please do not use this form.

1. Your MSL Code

Enter the code given to you by your employer or by MSL (for example: M-0147, S-0241, M-0147A for a dependant).

MSL ID Code

Your code links your referral to the correct organisation and contribution settings.

2. About You

We use these details to contact you and to match you with a suitable counsellor.

Full Name

Job Role / Relationship

Email Address

Phone Number

Preferred Contact Method

Preferred Counsellor Gender (optional)

3. What You Would Like Help With

In your own words, tell us about the main issues you would like to explore in counselling.

Presenting issues

How is this affecting your day-to-day life?

What would you like to achieve from counselling?

4. Availability & Preferences

When are you generally available for sessions?

Preferred Session Format

5. Safeguarding & Suitability

These questions help us check that MSL counselling is the right level of support for you.

Are you currently experiencing thoughts of harming yourself or others?

Are you currently under NHS mental health or crisis services?

Are you currently in any other counselling or psychological support?

If we feel that a different type of support would be safer or more appropriate, we will let you know and refund any payments made.

6. Sessions & Funding

This helps us match you to the right bundle and apply any contribution from your organisation.

How many sessions do you think you might want?

You can change this later with your counsellor. Our standard bundles are usually 6, 8 or 10 sessions.

How will the counselling be funded?

Anything we should know about cost or affordability?

We will check your MSL code against what your organisation has agreed. If your employer does not contribute, your counselling will be self-funded. Before you pay for anything, you will receive a clear breakdown showing the full bundle cost, how much your employer is paying (if anything), and how much you will pay yourself.

7. Consent

I understand that my employer will not have access to my session content or therapy notes.

I agree that MSL may share basic administrative information with my organisation where needed (for example that a bundle has been purchased).

I confirm that I have read and understood the information above and that I am submitting this referral voluntarily.

After submitting, a counsellor will review your information within 24–48 hours. If suitable, we will confirm your counselling bundle, arrange payment, and automatically invoice your employer for any agreed contribution.

MSL counsellors are independent practitioners and hold their own clinical notes in line with UK GDPR and professional ethical guidelines. MSL stores only minimal administrative data to manage your referral and payment.