Make a referral

We accept self-referrals from individuals aged 16-25 and those completed by a parent/carer for individuals under the age of 16. We also accept referrals from health, education, and social work professionals. For those over the age of 25, please see our page on help for over 25s.

Referrals are composed of two stages. The first stage has two parts. The first part of stage one is concluded by completing and successfully submitting the form below.

Once received, the individual referred (or their parent/carer if the individual referred is under 16) will then be contacted to confirm the details submitted in part one. Some additional information will also be gathered such as GP details and brief medical history. This completes part two of the first stage.

The second stage then involves a clinical assessment by a qualified therapist who will explore the reasons for referral, current presenting difficulties, and desired therapeutic outcomes. They will then advise on the most appropriate next steps. This will either be allocation to one of our practitioners or signposting to a more appropriate support.

Further detailed information will be provided throughout the referral process, however, if you require assistance completing the form or have any queries about making a referral, please do not hesitate to contact us.

To make a referral complete the form below...

Information about the person being referred

First Name

Last Name

Date of Birth

Best Contact Email Address

Best Contact Phone Number

House Number / Name / Street Address

Street Address Line 2

Town

Postcode

If the person being referred is under 16 years of age we require parental consent:

please provide details of an adult with parental responsibilities who we can contact to obtain this

First Name

Last Name

Email Address

Phone

Relationship to person being referred

Before submitting a referral for an individual under the age of 16, you must ensure the above named adult is aware of and in agreeance with this referral.

I confirm the above named adult is aware of and in agreeance with this referral

Information about the person completing this form

I am making this referral on behalf of someone else

Yes

If making this referral on behalf of someone else, please enter your details below

First Name

Last Name

Email Address

Phone

Relationship to person being referred

Agreement and form submission

By checking the box below, I agree to Insight Youth's privacy statement on the use of my information

I agreeView privacy statement

I confirm the individual being referred is between the ages of 8 and 25 and is in agreeance with this referral.

Thanks for submitting, we will be in touch soon...