Make a Referral

Who is the support for? *A child or young personA parent or carerMyselfOur family

What feels most important right now?Emotional wellbeing / mental healthBehaviour challengesAnxiety or low confidenceBig life changes or traumaI’m not sure — I just know we need support

Tell us a little about what’s going on (optional)

Are you or your child currently receiving support from any other services? (Optional – helps us understand how best to support you)NoYes – school-based support (e.g. SEN, pastoral, mentoring)Yes – GP or NHS mental health servicesYes – social careYes – private or community-based supportI’m not sure

Consent & Acknowledgement *I understand that Inspired Empowerment CIC is not an emergency service and that information shared here will be handled with care and confidentiality.I consent to Inspired Empowerment CIC contacting me to discuss support options.

Once you submit this form, a member of our team will respond with care and compassion.