Referral Form (Mental Health)

Please complete the form below with as much detail as possible.

Information you provide in this form is sent securely over the internet. If you would prefer not to use this form, you can contact us for alternative methods.

Please note: The form must be completed in one session as for security purposes, the information in it cannot be saved.

To start, select the relevent service and location below:

Service and Location

Supported Housing

Floating Support

Personal Details

Useful Contacts

Referring Agent

Community Psychiatric Nurse/Social Worker



Other (Probation officer, family, friend)

Aspects of Safety

Further Information

Current Income

Equal Opportunities Monitoring

I have read the Privacy Statement and agree to P3 processing my personal data.

Online Referrals

Mental Health Referral





Please follow the links below to find out
more about each organisation

Amber Trust LogoP3 LogoDerbyshire Federation for Mental Health logo