Launch Referral Form

Launch is an open access advice and information service which offers guidance and practical support to young people in areas such as housing, homelessness, budgeting, family relationships, employment, sexual health, well-being and substance misuse recovery. We offer free, confidential advice and support service for anyone aged 11-25 living in Hampshire, Surrey, Berkshire, West Sussex, Dorset, Swindon & Wiltshire

We offer in-person or remote appointments depending on your location. We are here to listen, offer guidance and provide practical support on a number of issues.

We do not provide help in an emergency. If you are concerned about the immediate safety of you or someone else then call 999 for emergency services or visit your local A&E.

If you are in need of urgent help we would recommend contacting your GP, NHS 111 or the following services:

Samaritans - 116 123

jo@samaritans.org

Papyrus - 0800 068 41 41

pat@papyrus-uk.org

Frank - 0300 123 6600

Should you have any questions in relation to this service, or referral form please email:

launch@stepbystep.org.uk or call 01252 346105.

Please tell us who is making the referral

Referrer Details

If you are referring on behalf of a child or young person please complete the section below. Please make sure you have gained the appropriate consent before making this referral.

Relationship with young person

Relationship - other

Referrer name

Organisation

Referrer contact number

Referrer email

If you are a professional working with a young person please outline your relationship with them and what work you have completed. Please also include details of other professionals working with the young person.

Young Person Details

First name

Last name

Date of Birth

Gender

Preferred pronouns

Ethnicity

Street
(including number/name)

Town/City

County

Post code

Mobile number

Parent/Guardian Contact Details

Please provide contact details of person with parental responsibility. This is an optional section and is not required.

Parent/Guardian name

Parent/Guardian contact number

Are you/the young person happy for parents/guardians to be contacted?

Reason for Referral

I/the young person would like support with

Mental health/emotional wellbeingDrugs and alcoholHousing and homelessnessSomething else

Please include details of the substance misuse concern

Include details of frequency and type of drug or alcohol use if known.

Please tell us what you are seeking support with?

Please provide details of other professionals that are supporting you/the young

person

Please tell us anything important that we should consider about the referral

Consent

We promise to respect any personal data you share with us and keep it safe. We aim to be clear when we collect your data about how it will be used, and not to do anything you would not reasonably expect. Our privacy policy can be accessed here - https://www.stepbystep.org.uk/view-privacy-statement/

If you are unable to accept our privacy policy, we will be unable to process your referral. If you have any questions about this please contact us by visiting our website or by calling 01252 346105.

I agree to Step by Step processing my information

Step By Step, 36 Crimea Road, Aldershot, Hampshire, GU11 1UD

01252 346105

launch@stepbystep.org.uk