SafeCall referral- professionals

Safecall - professional referral

If you would like to refer someone into SafeCall please use this form

Your details
Name of Referring Agency*
Referrer's First Name*
Referrer Details Last Name*
My email address is*
My phone number is
SafeCall Service user
Details for the person you are referring
Young Person's Name
First Last
Date of Birth
Month
Day
Year
Gender
Young person's mobile number*
Local Authority Area*
Their Care status
Involvement in Youth Justice (in the last 12 months)
Has the young person ever been reported missing to the police
- Yes
- No
- Don't know
Has the young person ever been missing from home but not reported to police?
- Yes
- No
- Don't know
Do you have consent from the young person to pass on their details to us?
- Yes
- No
- Don't know
Please give us a summary of your concerns about the young person*
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Safecall - professional referral

Your details

SafeCall Service user

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