Referral Form

The child needs to be referred before their 19th birthday and anyone, including families, can refer a child. Please complete the form below and don't worry if you don't have all of the information to hand immediately.  We can collate this at a later date. 

Complete our care referral form and send to care@martinhouse.org.uk, alternatively print the form and send to us at Martin House, Grove Road, Boston Spa, LS23 6TX. Health professionals should also complete and return the referral criteria form.

Care referral form

Referral criteria form