Referral Forms

Referral Forms

Select below to see the referral options for each service.

If you have any questions please get in touch.

Family Self Referral Form

If you would like to refer yourself please complete this form and we will get back to you by phone or email. Please note we can only work with you if you live in Edinburgh or Midlothian and one of your children is under 5.

We would like to to contact at least one of these people (above) to follow up your referral. Please include the name and contact details of one person from the list you would be happy for us to speak to.

Early Years Home Support Referral Form

The Early Years Home Support referral form is available as a Word doc download below.

You can find out more about this service here.

Download Referral Form

Therapeutic Support Referral Form

The Therapeutic Support forms are available as a Word doc downloads below.

You can find out more about these services here.

Systemic Family Counselling

Download Referral Form

Art Therapy for children up to 12

Download Referral Form

Back on Track Referral Form

The Back on Track form is available as a Word doc download below.

You can find out more about this service here.

Download Referral Form