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2020-21: Just Drop In YIA Ltd Signed Accounts 2021

Is This A Time Of Crisis?
Just Drop In Form

Fill in a form and we will come back to you

    First name of young person

    Surname of young person

    Name of parent/carer (if applicable). PLEASE NOTE: WE ONLY TAKE REFERRALS DIRECTLY FROM YOUNG PEOPLE/FAMILIES, NOT EXTERNAL ORGANISATIONS, INCLUDING GP SURGERIES.

    Young person's DOB

    Email

    Tel

    Preferred Method of Contact

    Young Person's Address

    Young Person's Postcode

    School/College (if applicable)

    GP Surgery

    Service (please click inside box below to select a service)

    Does the young person know about and consent to the referral?

    Reason for referral

    Accessing another service? (e.g.: CAMHS, Talking Therapies, etc)

    If yes, please provide name of organisation and referral reason

    Has the young person accessed a crisis service in the past 3 months? (e.g.: Crisis Line, A&E, etc)

    If yes, please provide details

    Is the young person waiting for an assessment with the Mental Health Hub/CAMHS?

    If yes, provide details

    Household in receipt of benefits?

    Are you happy to be added to the JDI mailing list to keep you informed of all the services we offer and when?

    We will only use the data you have submitted to contact you in response to this form in accordance with our Privacy Policy.Click here to view our Privacy Policy

    Our duty to ensure your safety and the safety of others is paramount. If we believe you or someone else is at immediate risk of harm as a result of the information you provide in your enquiry, we may need to take additional action. If you are unsure, you can ring us and talk through our confidentiality policy.

    Please note, replies to this form will come from hello@justdropin.co.uk which might go into spam/junk folders. We will aim to respond to you within 5 working days. Please do not use this form in a time of crisis, and follow the time of crisis button on the website instead.

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