Community Referral

Make a referral to us.

If you work for a company, healthcare provider, or community or voluntary sector organisation and would like to refer someone to access one of SUMMIT's free services, please complete this referral form.

Please note: Referrals to our Peer Support Worker service cannot be made through this form. They require a formal referral from a member of the Primary Care Mental Health Team.

Once you submit the form, our team will review the information as soon as possible. If the referral is appropriate for our service, we will contact the person referred using their preferred contact method. If we need any additional information, we will get in touch with the referrer using the contact details provided.

Please ensure the person being referred is aware of this referral and has given their consent for their information to be shared with SUMMIT. The information you provide will be processed in accordance with our Privacy Policy.

Your Information

Your Full Name

Your Email Address

Company Name

Reason for Referral

Your Message

Please tell us why you are making this referral, what support is needed (if relevant), and any information that will help us understand the person's circumstances.

File upload

Referral Information

First Name

Last Name

Telephone

Email Address

Referee's preferred method of first contact:

Telephone Call

Text Message

Additional Information

Is there anything the person would like us to know before we contact them? This could include communication preferences, accessibility needs, or anything they have asked you to pass on. Please avoid including confidential or sensitive information unless it is necessary for us to contact them appropriately.

I confirm that I have discussed the reason for referral with the person named above. They have agreed for me to share their contact details with SUMMIT so that they can be contacted by us.