Here For Each Other staff wellbeing service team member referral form

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Please use this form to refer a member of your team or a colleague to the Here For Each Other staff wellbeing service.

  • If you are here to refer yourself to the staff wellbeing service, please use our self-referral form.
  • If you are here to refer a whole team to the staff wellbeing service, please use our team referral form.

This online referral form is fully secure and all details below will be stored on our secure and confidential system. By completing this form you agree to these terms and to be contacted via any available method.

Once you submit the form we will be in contact with the person you have referred with an appointment offer as soon as possible.

Please ask them to monitor their junk/spam email folder so they don't miss anything from us.

If they require urgent mental health support, please contact the Dorset 24/7 Connection helpline on 0800 652 0190.

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About your staff member

Does your staff member have any disabilities? *
Please select all that are relevant
Has your staff member ever received treatment or support from mental health services? *

Your Staff Member's Contact Details

Your staff member job role

About you

Thank you for completing the form. Please press submit to send your referral to the Here For Each Other staff wellbeing service. We will be in contact with your staff member with an appointment offer as soon as possible. Please monitor your junk/spam email folder so you don't miss anything from us. If you require urgent mental health support, please contact the Dorset 24/7 Connection helpline on 0800 652 0190.
Mental health and wellbeing advice