Dialogue Parent Programme
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About this form
This is a referral form for YMCA Dialogue in West Sussex. We provide counselling and other kinds of therapeutic support to children and young people and their parent or carer. We work with children and young people aged from 11-18.
Please click Next to begin making your referral for our parent group programme,
"The role of parents in supporting young people with mental health problems"
Due to current Government guidance regarding COVID-19, we are unable to provide face-to-face work at this time.
We will continue to provide our services digitally and will regularly review this position.
Please note that this is not a crisis service and we do not provide urgent care
If you are seeking urgent help or advice and you are not in a life-threatening situation, the following sources of support are available:
Samaritans 116 123
HOPEline UK 0800 068 41 41
If you feel you or someone else are not able to stay safe, but do not need immediate medical assistance, you should contact:
Sussex Mental Healthline 0300 5000 101
ChildLine 0800 1111
Samaritans 116 123
If urgent medical assistance is needed please call 999.
We are careful about how we keep your data. We will only share information if we have to do so to keep someone safe from harm.
This is in accordance with general data protection regulations (GDPR).
To contact our team, please call or text us on 07739 893 707 with any queries or questions or email us at email@example.com. Secure emails from nhs.net or similar can be sent to firstname.lastname@example.org.
YMCA has been serving local communities for 175 years.
YMCA DownsLink Group is a charity that works to prevent youth homelessness across Sussex and Surrey and provides supported accommodation, youth advice centres, counselling and family mediation. Each year we support over 10,000 children, young people and families. Our main centres include: Brighton & Hove, Guildford, Horsham, Crawley, Eastbourne, Hastings and Worthing.
Click here to visit our website.
Please complete the questions below. This might take about 10 minutes to complete.
The answer is in an invalid format.
Please complete today's date
Please can you confirm you child is has been referred for therapeutic support from Dialogue Services within the last three months
Our service mainly works with young people aged from 11 up to their 18th birthday.
We are unlikely to accept your referral if your child is under
11 or over 18s.
* Please confirm your child's age range.
11 and 18 years old
Younger than 11 or older than 18
When was your child’s last appointment with us?
Less than 3 months ago
3 months ago or more
I don't remember or I'm not sure
on waiting list
What brings you here
* What would you like to gain from attending the parent programme?
Are you comfortable meeting with a group using virtual tools.
Do you have access to on line tools to attend the programme
How you like to be called
House number, building name, street name
Gender and gender identity
Trans-female Prefer not to say
Not listed/prefer to self-describe
Pronouns: Please refer to me by
Not listed (please specify):
Your email address (required for appointment confirmation)
* Preferred contact number (This is the number we will use to contact you about the group)
Can we leave a text message or voicemail on this preferred number?
Details of your child accessing Dialogue services
First name *
Date of birth
Are you, or is anyone else worried about your child’s safety? If so, please tell us why.
If a young person is in urgent need of support, please assist them to seek support from their GP.
If you're looking for other support in your area, try searching our e-wellbeing website.
You may also want to encourage the young person to check out the NHS website Every Mind Matters where they can find various bits and pieces to help with their emotional well-being.
You may wish to check the Young Minds for parents website.