Help and Support across Yorkshire and the Humber

9am-5pm Mon-Fri Call: 0808 2800 999

24 Hour National Helpline: 0808 2000 247

Self Referral Form

If you would like to self refer then you can either call the office on 01274 667104, or fill the form in below and a member of staff will call you as soon as possible. 

Please note - the member of staff will only speak to you. If they call the number you've given they will not say which agency they are calling from until they are sure they are talking to you personally. 


Please Note:

For professional referrals we ask for additional information. Please fill out the form linked below and email it to:

Download the Professional Form


Note: Please fill out the fields marked with an asterisk.