A human next step

Request a referral to professional therapy.

With your permission, Tranquiliva can pass your contact preferences to an independent therapist partner. The referral is free. Any clinical relationship, availability and provider fees are agreed directly with the provider.

Explicit consent No Tranquiliva referral fee Independent provider

A person reviewing independent therapy referral options on a phone

Referral, not treatment

Tranquiliva does not select a diagnosis, promise an appointment or supervise clinical care.

Private referral request

Tell us how the partner may contact you.

Please do not describe traumatic events, diagnoses or your full mental-health history here. The therapist can discuss clinical details directly with you.

1. Contact details

Name Email Phone or WhatsApp number (if selected) Preferred contact

2. Referral preferences

Where are you located? Preferred language Broad area of support Session format Best general time Accessibility request (optional)

3. Is there immediate danger right now?

If you may harm yourself or someone else, or are in immediate danger, this form is too slow.

No immediate dangerYes or not sure

Do not use this form for emergencies or detailed clinical records.

Request a referral to professional therapy.

Your request has a reference.