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Supporting recovery and restoration across Ayrshire

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Make a referral

Use this form to refer an individual into Freedom Fighters support services. A member of our team will review the referral and make contact within an appropriate timeframe.

Referrer's Information:

Referrer Name: *

Organisation / Service Name: *

Role/Job Title:*

Phone*

Email*

Relationship To individual:*

Individual Being Referred:

Full Name

Date of Birth *

Phone Number:*

Email*

Address*

Preferred method of Contact:

Phone

E-Mail

Referral Type

Please select the service you are referring the individual for:*

Please provide a brief summary of the circumstances and the support being requested. e.g -

• Presenting issues

• Relevant mental health concerns

• Substance misuse history (if applicable)

• Current support services involved

Reason for referral:*

Risk and Safety information:

Is the individual currently in crisis?*

Yes

Unsure

Any known risk to self or others?

Yes

Unsure

Any safeguarding concerns?

Yes

Consent

Has the individual consented to this referral?*

Yes

Please include anything else that may help us support this individual effectively:

Supporting people affected by mental health challenges, trauma, and addiction through counselling, community programmes, and transformative retreats across Ayrshire, Scotland.

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Get in touch

info@freedomfighters.life

Phone

0781 648 2323

Location

58 Glasgow Street

Adrossan,

Ayrshire

KA22 8EH

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