We encourage young people and adults to complete their own self-referral forms, with support if needed. These forms can be accessed here.

IMPORTANT: Due to extremely large waiting lists, we are currently only accepting referrals for group-based support or drop-in. Referrals for 121 support have been temporarily paused. 

If you feel it is necessary to complete this referral form on behalf of your son/daughter, please ensure that the information provided is an accurate reflection of your son/daughters own wishes, feelings, and support needs.

  • Completion of this form will assist with Daisy Chain’s internal triage process – please provide as much information as possible to support with this.
  • Completion of this form does not guarantee support. Daisy Chain can only support clients where we feel we can safely and appropriately meet their needs within the context of our service offer and specialism.

Terms and Conditions

  • Daisy Chain’s Wellbeing Service should never be used as a replacement for statutory mental health support.
  • By completing and submitting this form, you are consenting to Daisy Chain storing this information for the purpose of service delivery and client support.
  • Daisy Chain’s wellbeing service is not a crisis service or a 24-hour service.
  • If a client is already accessing mental health support, it is necessary for Wellbeing staff to liaise with their mental health practitioner as part of the triage process and before any support can be offered.
  • During group sessions, clients may choose to share their own personal views and experiences relating to wellbeing and sometimes mental health. Daisy Chain staff cannot always control what clients choose to share.
  • During sessions, there may be discussions relating to mental health and understanding the brain and body.
  • Parents/carers must ensure that the information provided in this referral form is an accurate reflection of your son/daughters own wishes, feelings, and support needs.
  • Where a client is 18+, Daisy Chain staff will ensure that the client agrees with all information provided in this referral form and will update referral information and records based on the wishes and feelings of the adult themselves.
  • Where a client is 18+, Wellbeing staff will liaise directly with the client regarding their support, unless otherwise specified by the client themselves.
  • Wellbeing staff will maintain client confidentiality at all times. Details of wellbeing sessions will only be shared with parents/carers under exceptional/necessary circumstances and/or with explicit consent from the client.
  • Parents must provide detailed and accurate information in the referral form and must inform Daisy Chain of all information necessary to ensure the wellbeing and safety of the client and others.
  • Completion of this form does not guarantee support. Daisy Chain can only support clients where we feel we can safely and appropriately meet their needs within the context of our service offer and specialism.
  • Daisy Chain will triage referrals and signpost clients to alternative services, if necessary.
  • Daisy Chain’s Wellbeing Service is for individuals aged 15+ who are autistic or who self-identify as autistic.

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