Please use this form to make referrals to our mental health services and ensure you have all information to hand as you cannot revisit it later.

PLEASE NOTE: You will need to have signed the relevant Service Level Agreement and/or have been given permission by YMCA Trinity Group’s Mental Health Services to make a referral so your setting name can be added.  If this doesn’t appear in the drop-down for that question, please contact us on or 01733 373187 so we can add you.

Programme referred to: (Mandatory completion - please tick the relevant box. Your referral may be rejected and need to be resubmitted if no programme is selected)