Making a referral online

The online referral system is for routine referrals only. If you need help urgently do not use the online referral please contact the Crisis Care Centre on  0300 123 0907 Option 1.

If it’s a life threatening emergency phone 999.  This is if your life or the life of someone else is at immediate risk.

Referrals can only be accepted if you live in Stoke-on-Trent or North Staffordshire and are under 18 years of age.  You can self-refer using the form below

We want to make sure that you receive the best help possible, as quickly as possible, from the best service for you.  The referral form asks for lots of information about you in order to achieve this.  If you can find somewhere quiet, where you won’t be interrupted, this will help.

Online referral form