Confidential Referral Form

Only fill in the form below if you are making a self-referral

• If you wish to make a referral about yourself please fill in the online form below or give advocate a call on 01904 414357
• If you are a professional please click the link to download the full referral form and follow the instructions at the top of the form.
• If you are family member or friend please click the link above to download the full form or give us a call on 01904 414357 for more details

Please note, we currently have an extensive waiting list of approximately 20 weeks.

Referrals made by the website form can take up to 2 weeks to process. If you need to make an urgent referral please call - 01904 414357