The Way Back Support Service – Referral Form

Please complete this form and return it, along with a copy of the care plan, safety plan and/ or assessment summary (if available).

A team member from The Way Back Support Service may follow up with you if more information is required to assess suitability or eligibility for the service.

If they are deemed eligible, a Support Coordinator from The Way Back Support Service will contact the person being referred.

Please ensure a consent form has been completed for each referral to avoid any delays.