Please read before taking a referral: The information you are providing us is confidential within our organisation. However, there may be times we have to breach confidentiality without your permission. This is in instances where we believe there could be an immediate risk to someone’s life or risk of serious harm or there is another safeguarding concern. Please continue if you’re still happy to continue with the referral.

e.g. phone, email etc.
Please include name and telephone number
Please include any access requirement or allergies.
Please rate your confidence level between 1 and 5, 1 being not very confident, 5 being very confident.
Please include name, organisation and email or phone number.