IMPORTANT – PLEASE READ

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. 

  • Please put as much detail as you can in this form.
  • It is ok if someone helps you to complete this form – but please make sure to include your true wishes, feelings, and support needs.
  • Completing this form does not mean we can definitely offer you support.
  • Daisy Chain can only offer you support if we feel we can meet your needs.
  • If we cannot offer you support as part of our Wellbeing Service, we will suggest other services that might be able to help.

 

 

Terms and Conditions

Please read the below terms and conditions carefully and then click to confirm that you understand. Referrals cannot be accepted unless the terms and conditions have been agreed to.

  • Daisy Chain’s Wellbeing Service should never replace mental health support.
  • Daisy Chain’s wellbeing service is not a crisis service or a 24-hour service.
  • During group sessions, other clients may choose to share their own personal views and experiences relating to wellbeing and sometimes mental health. These views may be different to your own opinions and experiences.
  • Daisy Chain staff cannot always control what other clients choose to share.
  • During sessions, there may be discussions relating to mental health and understanding the brain and body.
  • The information you provide in this form must be true, correct and you must do your best to tell us as much information as possible.
  • By completing and submitting this form, you are consenting to Daisy Chain storing this information for the purpose of service delivery and client support.
  • If you take part in a group session, you must respect the confidentiality of others and the information they share.
  • In most cases, Wellbeing staff will maintain your confidentiality and will not tell other people about your support or the information you have shared.
  • However, if you tell us something that makes us concerned for your safety or the safety of others, we might have to pass this on. We will speak to you about it first, if possible.
  • You must be 15+ to access this service and must be autistic or identify as autistic.

 

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