Professional Referral Form

To refer into our services:


  • The following form must be filled out accurately and as fully as possible so we can process your referral.
  • You must have obtained consent from the parent for us have their information and get in contact with them. If consent is not granted - or is withdrawn at any time - we will not be able to work with the parent.
  • All sections apart from 'Referring Professional Details' are related to the parent, carer or guardian and their situations
  • Behaviours must be identified by our team as CPA rather than typical boundary-pushing behaviour experienced by most parents.
  • We can only offer one-to-one support in our funded areas, these areas can and do change. However we can provide our standard level of support to anyone who is accepted into our services
  • Once we have received and processed your referral, we will get in touch with the parent by email, it is essential we have a safe email address to contact the parental figure on.
  • We DO NOT work with or have any contact with any children, including child aged 18 or over


*Please note, we currently have a high volume of referrals which means we have a 15 working day response time. *


Click here for Referral Form