We accept referrals from professionals and family members for children and young people aged 3–18 living in Nottinghamshire, Lincoln City, and the Kesteven districts of Lincolnshire who have been affected by the death or terminal illness (with a prognosis of 12 months or less) of someone important to them. We also accept self-referrals from adult family members closely connected to a child or young person referred to our service.

How to access support

As much as we would love to be there for everyone, we do have some criteria for accessing our support. Before submitting a referral please check the eligibility criteria document to ensure the child or young person meets our referral requirements, and then complete the correct online form from the list below. 

Important Information: Fields marked with an * are mandatory and must be completed before the form can be submitted.

Please provide as much information as possible when completing the online referral form, as incomplete information may delay the referral process or result in the referral not being accepted.

Please complete one referral form for each child or young person. If you are referring more than one child, submit this form once for each child. 

Important for support following a suicide bereavement. Please click here

Get in touch.

If you have any questions or would like to talk things through before making a referral, please do get in touch. Calling us is usually the quickest way to get the information you need, as it avoids delays from back‑and‑forth emails. 01636 551739 or send us an email.

If you are a Parent/Carer please use this form to refer your child.

If you are a Professional please use this form to refer a child.

Adult self-referral form Important Note: Adults MUST be closely connected to a child or young person that is also referred to our service and refer themselves. (We do not accept referrals for adults submitted directly by professionals. However, a professional may support an adult in completing and submitting the referral if assistance is required.)

Thank you