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Welcome to Safe Connections. We are a local Suicide Prevention Service for those struggling with suicidal thoughts and feeling that life is no longer worth living. We are not an emergency service. If you are in crisis, call 999 or visit your local A&E for urgent support. For non-emergency medical advice, please contact 111

Please note that all fields with a red * are compulsory and must be completed before you can submit this form.

Identity

Forename

Surname

Date Of Birth

Referral reasons

Professionals & Self-referrals - Describe the reason for referral, including current experiences/symptoms, any suicidal thoughts, attempts, plans, and specific support needs

Address

Address 1

Address 2

Town

Post Code

What borough do you live in?

Demographic

Gender

Is your gender the same as the gender you were assigned at birth

Ethnicity

Religion

Disability

Sexuality

Contact

Mobile

Contact - Next of Kin / Emergency contact

Next of Kin - Name

Next of Kin - Contact Number

Contact - GP

GP Surgery name

Safe Connections Suicide Prevention Hub

Client Registration form