Make a Referral

We are dedicated to providing the best possible support for those in need.

Please share some information about the individual you are referring and the type of support they require. Their wellbeing is our top priority, and all information will be treated confidentially.

You can refer someone to the Sanctuary using this online form or by calling us on 0300 330 9492.

Once you have submitted the online form, or referred the individual by calling us, our team will contact them on the number provided within 24 hours. Please note, the call will come from a private number.

Whether the person you are referring is experiencing a mental health crisis or needs support to stay well, we can provide them with a safe, supportive space. Our service is available 7 days a week, 365 days a year.

Please note—We can only support individuals over the age of 18.

Referrer Information

Full name

Position Organisation

Contact Number Email Address

How Did You Hear About Us?

Select an option: If Other, please specify:

Client Information

Full name Date of Birth

Address

Postcode

Contact Number Email Address

Emergency Contact Name Emergency Contact Number

Emergency contact information will only be used if there are concerns about the individual's safety.

How Can We Help?

What kind of support do you think the individual needs from our service? What challenges or issues is the individual currently struggling with? How are these challenges affecting the individual’s daily life?

Demographic Information

We collect this information to ensure our services are accessible to all groups and meet the needs of our diverse community.

Gender Ethnicity

I give permission for Mid and NE Essex Mind to store my data (We cannot proceed without this permission). You can view our GDPR Confidentiality statement here.

Make a Referral

Referrer Information

Client Information

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