Refer yourself as a carer

Your details

Name*

Phone*

Email

Who are you caring for /concerned about?*

Please make sure this person is aware you are making a referral as we can only help someone who agrees to our support.

Name*

First Last

Phone*

Email

Relationship to me*

Age of person*

Additional information

Anything you would like to tell us

Please tick to confirm that:*

You have discussed with the person you are referring
The person you are referring is aware that Jami is a mental health charity
The person you are referring is aware that you are giving Jami their name and contact number

How did you hear about us?

Other

We’d like to send you updates about other things happening at Jami

I would like to receive by email or other e-communication information on Jami’s services, courses, events and fundraising
No thanks

You can learn more about how we handle your personal data and your rights by reviewing our privacy notice