Please be sure to read our Referral Guidelines before you complete this form. Thank you so much.
We want to start supporting anyone that needs us as soon as we possibly can. But demand for our services is continually high. After you’ve completed the referral form, we will send you an email letting you know about our current waiting times for appointments. Thanks for your patience.
Please note that all questions with red asterisks (*) are mandatory. If you don’t complete these fields, you won’t be able to submit the form.
We recognise that maintaining the confidentiality of certain information is necessary and we are committed to practices and procedures that reflect this.
We believe that information our service users give to us in confidence should only be used for the purpose intended by the service user. Our staff and volunteers will not normally divulge information that could compromise a person’s safety or right to privacy.
However, there may be times when a member of staff or volunteer considers it necessary to disclose information to others within the organisation or an outside agency for the sole purpose of the safety and wellbeing and the service user and/or their family members.
Please note that information contained in this form will be stored and processed as part of our legitimate interests. Full details are contained in our privacy statement. If you’re referring someone else, please make sure that your referee is aware of this.
Thank you very much for your referral. We will get in touch with you as soon as we can.