The information you submit is safe. Data you send via this form is encrypted and is stored securely on HelloSelf servers.


Every Self Better.
Thank you for choosing to work with HelloSelf.
Fill in the form to make your referral.
Once your referral is received we will get in touch with them and keep you updated on their progress.
We match everyone to the best therapist for them so please provide as much information as possible. If you have additional clinical information to aid with matching, please send it securely to hello@helloself.com.
We promise to give your referral the best experience and the best outcome possible as part of our Every Self Better promise.
Thanks again.