A Referral Form will be required to be processed by a member of the team before we will process Support Package purchases or registrations for Zoom events.
Please fill out as much as you can; Mandatory Sections: G.P details, Personal Contact details and Next of Kin.
Your information is being collected on behalf of Sole Survivor (Wirral) Ltd. With your permission it may be shared with other agencies who work with us to assist you with your recovery. Sole Survivor (Wirral) Ltd are registered with the Information Commissioner's Office (ICO) so you can be sure that all information you provide will be treated in the strictest confidence as per legislation.
Referring Organisation Details (if applicable)
Details on any additional support services (if applicable)
Self Harm & Suicidal Ideation