General referral

Tell us the basics.

For individuals, parents, carers and families. We will use this first step to identify the right follow-up route.

You do not need to tell us everything here.

Keep this stage brief. We will ask for consent, detailed needs and relevant risks only through the appropriate secure process.

Do not include medical details, criminal-record information, a full case history or urgent safeguarding information in this form.

General referral details

Who are you referring?Your full nameEmail addressTelephoneReferred person's first nameFirst name only at this stage.Age bandBorough or postcode districtArea of interestBrief reason for referralMaximum 500 characters.Preferred contactTimingI confirm that I am authorised to make this referral and to provide the minimum information entered here.I have read the Data Protection Notice and understand that the detailed stage will use a separate secure route.

This form is not monitored continuously. If someone is in immediate danger, call 999. For urgent safeguarding concerns, follow the relevant setting or local-authority procedure.