Refer a Family Member to Scottish Families

If you would like to refer someone for support from Scottish Families please use this form.

They will be contacted by one of the Scottish Families team within 5 working days but this is generally quicker.

We will keep your information confidential and will not share it with third party organisations or use it for marketing purposes.

We will inform you of the outcome of the referral.

Referring Professional

Name *

Organisation *

Job Title

Professional's Phone Number

Professional's Email *

Who are you referring to Scottish Families?

Title *

First Name *

Last Name *

Age

Address Line 1

Address Line 2

Town

Postcode

Contact Phone Number

Best Contact Time

Can we leave a message?

No message will be left if no consent given

Email Address

Consent

Yes No

Has the person consented that their details can be shared to Scottish Families?

What is the referral regarding ?

Person who uses substances Person who has died

Reason for Referral *

Family Support Bereavement Support