Please provide as much information as you can. We will get in touch as soon as possible to explain our service and gain consent from the young person. Please note that for us to work with young people under the age of 16 we need to get consent from a legal guardian. 

Young person's information

Name and contact number
This could include CYF, school counsellore, number 10 etc

Referrer Information (If you are referring yourself just put "self" in these boxes).

What's going on?

Please outline alcohol/drug or mental health concerns
e.g. young person's family situation, accommodation, education, employment, relevant history