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Surveys / Arolygon
Complaints & Compliments form
Home
About
About us
Working with us
The Clinical and Quality Team
Our Initiatives
Candidate hub
News and updates
Services
Residential Children’s Homes
Join our team
Complex Care Roles
Join us
Make a referral
Contact Us
Contact Us
Surveys / Arolygon
Complaints & Compliments form
Refer a young person
We're here to support young people with complex needs through thoughtful, tailored care. If you know a child or young person who may benefit from our specialist residential care, please complete the referral form below.
Client referral form
About you
The person making the referral
Name
(Required)
First
Last
Email
(Required)
Contact number
(Required)
About them
The young person being referred
Name
(Required)
First
Last
Date of birth
(Required)
DD slash MM slash YYYY
Placement and support needs
Preferred location or region:
Is this an emergency or urgent placement?
Yes
No
Please indicate a timeframe:
Supporting documents
Please upload any relevant documents that will help us understand the young person’s needs, such as care plans, risk assessments, or reports.
Max. file size: 16 MB.
Consent
Permission to share their information safely
Consent
(Required)
By ticking this box, you are confirming that you have permission to share this young person’s personal information and make this referral. The information provided will be used to assess their needs and may be shared with relevant professionals involved in their care, in accordance with UK GDPR and health and social care regulations.
I confirm that I have permission to share this young person’s personal information and make this referral
