Referral Forms


In order for us to support our clients to the best of our abilities we will need some information about the problems you are having.

The Self-referral Form should take about 10 minutes to complete. Please complete all parts of the Self-Referral Form in as much detail possible.

When we have received your form one of our team will contact you to discuss how we can support you.

Completed forms should be returned via email to


Professionals referring into HANA should ensure they complete the referrer’s details section on the Referral Form as we may wish to contact you for further information. Please also make a note of the individual’s level of English as well as any first languages.

We will aim to respond to all requests for support within 2 working days.

Completed forms should be returned via email to