The below form can be used to submit a referral to us for either yourself or a child / young person that you know.  

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The information you provide will be stored securely and used to determine whether we are able to offer support and what that support could look like.

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Whilst we respect your right to confidentiality, we may need to share some of the information you provide if it suggests that you may be at risk of harm.  If we need to share anything we will let you know, unless there is reason to believe that doing so could cause you more harm.

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Please complete the form, providing as much detail as possible.  This will help us to offer the right support for you or your child.