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Refer a child or young person for bereavement support

This form is for under 18s only. We offer bereavement support to children and young people in north east Essex, no hospice connection is needed. If the person who has died was a patient of St Helena within the last two years and your family received support from a family support worker or counsellor, please call SinglePoint on 01206 890 360 to make a referral for bereavement support instead of completing this form. To refer a child or young person for support please complete the form below - it should take around 10-15 minutes. Fields marked * are mandatory and must be completed before you can submit the form. When you correctly submit your referral a reference number will be given to you on screen. If you do not see a reference number once you have submitted your referral please check you have completed all of the mandatory fields. If you are referring multiple people for support, please complete one referral form for each individual. If you experience any technical issues please contact the bereavement team on 01206 984 274.

If the person who died was a St Helena patient please call SinglePoint on 01206 890 360 to make your referral and do not submit a referral via this form.

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