Refer yourself as a carer

Your details
Name*
First
Phone*
Email
Who are you caring for /concerned about?*
Their details
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

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