Youth Services CIC

Make a referral

School / Professional Referral

For schools, local authority teams, social care, health and other services referring a young person to Youth Services CIC.

1 Referrer details
Please fill in this field.
Please fill in this field.
Please fill in this field.
Please choose an option.
Please enter a valid email address.
Please fill in this field.
2 Young person’s details
Please fill in this field.
Please fill in this field.
Please fill in this field.
Please fill in this field.
Please fill in this field.
Please choose an option.
Please choose an option.
Please fill in this field.
Please fill in this field.
Please fill in this field.
3 Reason for referral
Areas of need Choose all that apply.
Please choose at least one option.
Which stage of our model do you think fits best?
Please choose a stage, or “Not sure”.
Is counselling or therapeutic support being requested?Youth Services has in-house counsellors. Support can include CBT-informed approaches where appropriate.
Please choose at least one option.
Describe the concerns, how long they have been present and any recent changes.Please fill in this field.
Please fill in this field.
Interventions or support already in place or completed.Please fill in this field.
4 Risk & safeguarding
Please choose an option.
Including any risk to the young person, to others or to staff, and any exploitation concerns. Write “None known” if none.Please fill in this field.
Name, role and contact details of other professionals involved (for example social worker, CAMHS, youth justice, early help).Please fill in this field.
5 Consent & funding
Please choose an option.
Please confirm to continue.
Please confirm to continue.
Please confirm to continue.

Fields marked * are required.

Referral received. Thank you.

We’ll review the referral and contact you to discuss it and agree next steps. If risk increases in the meantime, follow your safeguarding procedures.

Back to schools & professionals