About your referral

Has the young person given consent for you to make this referral?

We are unable to accept a referral from anyone other than the young person or adult with parental responsibility. Please call our Initial Contact Team on 01260 290000 during our office opening hours.

We are unable to accept referrals without the consent of the young person. Please contact our Initial Contact Team on 01260 290000 during office opening hours to discuss how we can support you.

Young person's details

Have you (young person) received support from Visyon before?
Please ONLY provide this if the young person is over the age of 16 OR you are the young person referring yourself.
We will typically call you back during our office hours - Monday to Thursday, 9am to 5pm.
Other support needs

Referrer details

Leave this section blank if you are the young person referring yourself.
Your relationship to the young person
Do you and the young person share an address?

Place of education

Start to type the name of the school for the drop down list to appear.
ONLY if not listed above

Young person's GP

Start to type the name of the GP surgery for the drop down list to appear.