Make a professional referral

This form is for professionals wishing to refer an adult who would benefit from our suicide bereavement support. Once the form has been completed, a Dragon will be in contact to discuss the suitability of the referral. If you are looking to refer a child or young person, please see our ‘Children & young people’ page for more information.

Children & Young People

Professional Referral Form

Full name:

Organisation:

Role:

Telephone Number:

Your email address:

Please tell us about the person you are referring:

Name:

Age:

What kind of support are they looking for:

Which office would be their preference to visit:

Have they given you consent to contact us?:

In what capacity are you currently supporting this person?:

Please detail any additional support this person is receiving:Any additional information about the person you are referring that might be helpful for us to know:

In ticking this box I am indicating that the referee is aware that the referral is being made and has given verbal consent for Pete’s Dragons to make contact regarding support. Tick to confirm

Tell us a bit about the person who has diedFull name:

When did they die by suicide?:

What was the relationship between the person you are referring and the deceased?:

Please provide any additional information about the person who died, or the circumstances of the death, that might be helpful for us to know:

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Thank you

Thank you for recommending this referral to Pete’s Dragons. A member of our team will be in touch within 2 working days to discuss the suitability of the referral.Please note, referrals are not processed until this call has taken place.

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