Stay Well On-line Referral Form
Stay Well is an emotional health and wellbeing service for children and young people experiencing mild to moderate mental distress – providing a range of group and 1-2-1 interventions.
Referrals are accepted for children and young people:
o Aged between 5 to 18 years
o Who are experiencing anxiety, low mood, low self-esteem, difficult emotions and grief
o With a Staffordshire postcode, (home, school, or GP, excluding Stoke-on-Trent)
For children and young people who are in Stoke-on-Trent – please visit here for more information – unfortunately, we cannot accept your referral through this on-line referral.
Please note that Stay Well:
– Will only accept referrals where self-harm is present if the self-harm is superficial (i.e. it has not required medical attention)
– Does not provide assessments or diagnoses of the following conditions: ASD, ADD, ADHD or ODD
– Will assess referrals and allocate to the most appropriate form of intervention. This may include sharing referral information with NHS partner services to ensure that the child or young person reaches the most appropriate intervention.
– If you are a professional, children and young people with complex presentations should be referred to the central referral hub :
North Staffordshire, click here;
South Staffordshire, click here.
Before proceeding with the referral, you must have consent from either the child or young person, or from a person with parental responsibility.
You must also have the child or young persons NHS number. One of the easiest ways to find your NHS number is online, all you need is your name, address and date of birth – Your NHS number can be sent to you via text, email or letter – visit here. You can also find your NHS number on your prescriptions, hospital letters, hospital appointments and test results. Alternatively, you can ask at your GP
The referrer and the child or young person, or a person with parental responsibility must also be aware of how data will be handled through the referral process and beyond. This information can be found in our privacy policy.
All boxes in red must be completed.
By submitting this form you agree that you have read our privacy policy and understand in what circumstances your information may be shared with a third party.