Home→Get Support→For Family and FriendsSupport for Family & FriendsGet support for children, young people and adults up to 25 years struggling with their Grief New Professional / Family & Friends Referral (Public) You are manually adding a new record. Please complete the information below. Text messages and email notifications will not be sent. When you have submitted the form, you will be redirected back to the e-office where you can complete the full (background) information.Unique IDHiddenReferral Type Your name* Your relationship to those needing support*ParentCarerGuardianFriendProfessionalOtherYou specified 'other' above. Please specify the relationship: Have you talked to them about this referral? Tick here if yes Please do this before sending this formI am the parent/guardian I am the parent/guardian If you are not the parent/guardian please confirm: I have consent to share their details I consent to Star Bereavement holding my contact details on their secure database solely in regards to this referral I consent to Star Bereavement holding my contact details on their secure database solely in regards to this referral Your contact detailsYour mobile number*Your email address Your organisation (optional) The above details are the same for the child/young person needing support These details are the same for the child/young person needing support Parent/guardian name* Parent/guardian mobile number*Parent/guardian email address Who needs support? Please add as many children and young people from the same family as you need to. Use this plus button to add entries.Who needs SupportNameAgeGenderWhere they live Add RemoveWhy do they need support?*-- Please select --Someone important to me has diedSomeone important to me is near the end of their lifeBy submitting this form, I confirm I have read and agree to Star Bereavement's Data and Privacy PolicyI agree to Star's Privacy Policy* I Confirm I Have Read and Agree to Star Bereavement's Data and Privacy Policy CAPTCHA
