Make a Referral

People may self refer by calling 01324 635661 and speaking to one of our professional and friendly team or by downloading the appropriate referral form below. 

When completing this referral form for support from CEA, please complete all or as much of the form as possible in order to help expedite the referral process. If the form is not complete a member of our staff will contact the referrer before the referral can be accepted.

We also accept referrals from all agencies including but not limited to Police, Housing, Health, Social Work Services and Voluntary Organisations. 

Adult Referral 

To make a referral to our Adult Service download the form here: 

To submit your completed form, please see below. 

Children and Young People Referral 

To make a referral to our Children and Young People Service download the form here: 


What referrals would the CYP service not accept?

We always try to help where we can and have an excellent team of trained and competent staff and volunteers so if in doubt ask us and we’ll see what we can do. If we can’t help we will try to find services that can.

Will you take a referral without the client’s permission?

We need parental consent from non-abusive parent to commence work with children and to plan support tailored to individual. CYP aged 13+ can self refer.

What happens when we receive the referral?

The CYP service will meet with the parent / carer and / or referrer to conduct initial interview and assessment paperwork. This helps us to learn about the childs experiences and how they have been impacted which allows us to provide the right support. We will discuss support options with you and let you know when support will start. We also involve CYP in this plan and they will be able participate as part of our introduction and getting to know you sessions.

Where will support take place?

We will usually meet children in schools. This is usually a familiar and safe environment but if for any reason this is not suitable we can consider other options. The priority is that CYP are comfortable in our meetings.

To submit your completed form, please see below. 

How to submit your completed form 

  1. Download the appropriate referral form to your computer. 
  2. Once you have completed the form, save it somewhere safe where you can find it. 
  3. Check that your completed form has saved successfully onto your computer and that it can be opened. 
  4. Use the upload facility below, click on ‘choose file’, find the form on your computer and click the submit button. 

Alternatively, email the form to us at: 

Upload your completed referral form here: 

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    If you are experiencing domestic abuse and need immediate help, ask for ‘ANI’ in a participating pharmacy.
    ‘ANI’ stands for Action Needed Immediately. If a pharmacy has the ‘Ask for ANI’ logo on display, it means they’re ready to help. They will offer you a private space, provide a phone and ask if you need support from the police or other domestic abuse support services.

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    If you would like to learn more about our work, volunteer with us or make a donation to help us continue our work, please contact us by phone on:
    01324 635 661