Enquiries

To make an initial enquiry about a possible referral contact Director of Care Norma Powell on 01204 383396 or 07787482237 or fill in the below form.

Submitting this form will allow us to give an initial response as to whether we are likely to have a vacancy should you wish to pursue a referral.

Our reply will be to the e-mail address provided unless a telephone response is specifically requested.

Social Workers details

Name:


Office Address:


Telephone Number:


E-mail:


Local Authority:


Young Person's details;

Identifying initials:


Age:


Gender:
Male Female

Has the young person been assessed as in need of therapeutic residential placement?
Yes No

Current placement eg family home, foster home, residential home:


Approximate date Placement would be required from:(dd/mm/yy)


Expected length of placement:


If we are likely to have a vacancy do you wish to be contacted by telephone to discuss further?
Yes No