Below is our referral form for you to download and complete.

You can return the completed referral to us by secure email  to or via post to:
Private & Confidential, The Manager,  Patrick House, 58 Leigh Road, Leigh,
WN7 1QR.

Do not hesitate to phone the office on 01942 679352 if you wish to discuss this prior to sending.

Upon receipt of the referral, we will send an acknowledgement letter to the family, with additional information and we will arrange a home visit and a Young Carer’s Assessment as appropriate.

Click the link below to download the form.

Referral Form July 2018

The following document outlines the prioritisation criteria for longer term support set by our Trustees.  These should help you to manage expectations with children and families that you are referring to us. 

Eligibility Criteria January 2019