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Referral form

Update for new referrals: due to a high volume of request we are CLOSED TO NEW REFERRALS. We want to provide the very best service possible and in order to process every request in a timely way we are closed to new referrals. We will announce when we will open new referrals when we are able to do so. We are sorry for any disappointment this may cause. We will provide an update at the beginning of December.

If you would like to submit a referral to our services please complete and submit the form below by clicking on the button 'Make new Referral' below this paragraph. 

When entering your mobile phone number please us the +44 format and omit the 0 at the start of your number (example: 07876 543 321 becomes +447876 543 321) . We request this as we use a messaging service to communicate appointment information to you.

When we make contact about your request we will send information about our service, consent forms, an initial survey and some online assessments to complete to give us more information. ​To save any delays please ensure you have completed and sent everything back via the secure links you are sent on text and email. We will be in  touch as soon as we are able to do so. The reason we ask for information ahead of appointments is so that we can match you with the most appropriate clinician. To read more about this process please click on the button 'Referral process' below. 

NB: If you are an adult completing this on a child's behalf please select "Someone else" and seeking support for a "child".

If you are in need of urgent support, please contact one of the following services:

  • Text "SHOUT" to 85258 - this will connect you to ShoutUK, a free and confidential 24/7 support service

  • Call 116 123 - this will connect you to Samaritans, a free 24/7 helpline

For all other enquiries, please contact us via:

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