LOWDOWN REFERRAL FORM
for 11-25 year olds who live in the NN1-NN7 postcode areas to access the lowdown‘s services
This form is for self-referrals and assisted self-referrals to access the lowdown’s services. An assisted self-referral is when you have someone who is helping you to complete this form. The information you provide will enable us to offer the most appropriate services and actions. It will be kept confidential and securely stored and shared as appropriate within the lowdown.
Confidentiality is central to our work but it is not absolute – there are legitimate exceptional circumstances which require the lowdown to share information with others, such as; if a person is at risk of serious harm by others; if a person is at risk of serious harm to themselves, or to others; or there is a risk of serious crime. View our Confidentiality and Privacy policies (copies are available on request).
Some information will be used for reporting purposes; in these cases the data will contain no identifying information that could associate you with receiving a service. Any other information will not be released without your consent unless required by law or a court order as stated above.
We are not able to offer you counselling / therapy if you are seeing another counsellor or psychological therapist, or if you are currently receiving a high level of Mental Health Care. In those cases, we might be able to offer you another support service which is not counselling.
Prior to, during and after you receive a service, you can contact the lowdown at 01604 634385 or send an email to email@example.com for any questions you might have. Please complete the form as fully and as accurately as you can.