1. Who are you?
If you are a clinician or another type of professional please ensure that you help fill this form out with the patient rather than on the patient's behalf.
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1. This service is only available for people aged 13-17. Please confirm that you, or the person you are referring, is within this age range.
Please Note: If you, or the person you are referring, is aged 12 or under, or aged 18 or over, we will not be able to accept and process the referral. If this is the case, please visit our website (www.brightonandhovewellbeing.org) for other options. *
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2. Are you a Young Person, Professional or a Carer: *