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Support referrals

Referral Form

Use this form to refer a child, young person or family for support from Dimobi Children Disability Trust.

Urgent safeguarding — this form is not for emergencies.

If a child or young person is in immediate danger or at immediate risk of serious harm, call 999 immediately. For urgent safeguarding concerns that are not an immediate emergency, contact Children's Social Care or the police on 101.

Dimobi Safeguarding Contact — Email: info@dimobitrust.org.uk · Telephone: 0161 937 5332.

1. Your details

Preferred Contact Method *

2. Who are you?

I am making this referral as a *

Other:

3. Child/young person's details

4. Support required

Please tick all that apply

Other:

5. Diagnosis

Does the child/young person have a diagnosis?

6. Professionals involved

Professionals currently involved

7. Safeguarding

Are there any current safeguarding concerns? *

Is the child/young person currently at risk of harm? *

If there is immediate danger, do not wait for Dimobi to respond — call 999.

8. Tell us how we can help

9. Consent & privacy

10. Keep in touch

Would you like to receive Dimobi news and updates?

After receiving your referral, a member of the Dimobi Children Disability Trust team will review it and contact you regarding the appropriate next steps. You can also email your referral to info@dimobitrust.org.uk or call 0161 937 5332.

Referral form