Referral Form

If you would like to refer a young person for support, please fill out the short form below, a member of our team will then be in touch within 24 hours. Please do check your spam/junk email folder, just in case the email lands there.
Please make sure that the young person you are referring is 21 or younger and that you have their consent before submitting your details.
* indicated a required question

About the young person you want to refer

Permission to contact/GDPR consent

By submitting this form, you are giving us consent to make contact with the young person you are referring via text, email or phone. Please select the preferred method of communication or select all 3.
The young person can unsubscribe from our service at any time by letting admin@stopbreathethink.org.uk know.