Getting support for your emotional well-being

This form is for young people to ask for help from the Emotional Health Triage. PLEASE DO NOT USE THIS FORM IF YOU ARE A PARENT , GUARDIAN, GP, TEACHER OR OTHER PROFESSIONAL. Parents, guardians, GPs, teachers and other professional can make a referral by clicking here.

  1. Emotional Health Triage Logo

    Need help?

    If you're aged between 11 and 19, and you're feeling down, worried, confused, or you're having trouble with friendships or at home, then the Emotional Health Triage can help.

    If you're under 16 years of age we'll need permission from your parent or guardian before we can support you, but we'll keep your details private. We'll also talk with you about a comfortable place to meet, whether that's at your school, home or another place you feel safe.

    Just fill out the form on this page and we'll get in touch about ways we can help.

  2. Agreement
    1. Do you give us consent to store and share information with the NHS and other organisations as required to ensure we can offer you a service?
    2. Consent to this is required to complete and submit this form.
  3. First Name
  4. Last Name
  5. Date of Birth
    1. For example, 20 03 1976
  6. To see how we use and store your personal information in line with GDPR please read our privacy notice.