We are accepting referrals. There is a waitlist and if we are unable to provide a space in 6-8 weeks we will review and may discharge. See our Signposting page for other suitable services.

If you need to speak with someone now, call Childline 0800 1111 and someone will listen. Over 18? Call Samaritans 116 123. (Both are FREE)

If it is an emergency, call 999. Last updated 02/12/2020.

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Referrer

Referrer Details

Young Person

Young Person Details

Disability

If the young person considers themselves to have a disability please select the most appropriate definition. If the young person has multiple disabilities please select the definition that reflects the predominant disability.

Our service is currently provided digitally. Please let us know what adjustments we can make for your access.

Additional

Young Person Additional Contact Details

Safe Emergency Contacts

(Must be over 18 and at least one to be in the current household.)

Referral

Referral

(tick all that apply)
Tick the main reason(s)
Tick any that apply
Please add details of the intervention(s):
Please name any other organisations or workers involved in the the clients welfare: