Seahorse referrals - Professionals

If you are not the main caregiver, have you asked for consent to make a referral on their behalf?(Required)

Professional details


Carer's details

Main carer's name(Required)

Young person's details

Their name
As we move towards joined-up working with other healthcare organisations, providing us with your unique NHS number enables us to quickly and accurately find you and the people most important to you, to facilitate improved care, treatment, counselling and support.
DD slash MM slash YYYY
Their address
Is the young person aware that a referral is being made?(Required)
Was the deceased under hospice care?(Required)

Child's Next of Kin

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