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Please proceed if you can answer YES to the following questions,
  • If they have struggled with addiction, have they been abstinent for 3 months or more?
  • Has the participant been stable for a minimum of 6 months following a psychotic episode?
  • Have not attempted suicide within the last six months.
  • Has no current suicide ideation or plans to harm themselves.
  • Is this person able to engage with guided self-help, small goal setting and be able to work towards them?
  • Are they located in the Bournemouth, Christchurch and Poole area?
Please tick the box below to confirm and proceed
Has the participant consented to this referral?

Referrer Information

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Address

Participant information

Name
Address

Please provide details about any of the following risks you are aware of

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