Seahorse Project - self-referrals

Thank you for your interest in our Seahorse Project. Please complete the form below and we will be in touch as soon as possible.

If the young person is under the age of 13, has the main caregiver given consent on their behalf?(Required)
Is the young person aware that the referral has been made on their behalf?(Required)

Your details as the referrer

Name(Required)

Young person's details

Their name
DD slash MM slash YYYY
Their address
Have you or a family member been previously supported by the hospice(Required)
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