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    Refer Someone Form

    If you are a GP; the police; a school; a statutory or voluntary organisation; a parent, family member or friend and would like to refer someone to RoSA, you can do so by securely providing your and your client’s information below. One of RoSA’s specialist counsellors will contact the referred client..

    The following information is about the person (Client) that you are referring to RoSA.

    I consent to my data being stored for administrative purposes.

    We’ll store the information entered here for up to 30 days for administrative purposes only.

    View our privacy policy.