This form is to help us understand your current situation and how we may be able to support you.
We will keep all information in line with our confidentiality policies.
Our programme accepts self-referrals and supported self-referrals (in other words, if you are making this on behalf of someone else, they will be completing this form with you).
I am completing this form about myself
If you need help with completing the form, or if you have any questions, please call 03450 138 208. Also, please tell us about any services who you are working with already. We won’t contact anyone without your permission.
I am being supported to make a self-referral by someone else
Please ensure that you put the details of the person supporting you on the form so that we can contact you both to discuss the referral.
If I am not the person I'm referring
Please call the engagement team first on 03450 138 208 to discuss. We can talk about the best way of making a referral with you.