Please use the referral form below, completing all sections, to refer your client to our Acacia services.
Please ensure that you are familiar with our referral criteria here before making the referral and if you'd like to discuss specific cases/exceptions prior to referral please ring 121 301 5990 for assistance.
All fields highlighted in red are mandatory.
There are missing mandatory fields, which are indicated by red lettering stating that it is a required field.
Please check the fields and submit the form again once completed.
We recognise that maintaining the confidentiality of certain information is necessary and are committed to practices and procedures that reflect this. We believe that information our service users give to our staff or volunteers in confidence should only be used for the purpose intended by the service user. Our staff and volunteers will not normally divulge information that could compromise a person's safety or right to privacy however there may be times when a member of staff or volunteer consider it necessary to disclose information to others within the organisation or an outside agency for the sole purpose of the safety and wellbeing and the service user and/or their family members.
Please note that information contained in this form will be stored and processed as part of our legitimate interests. Full details are contained in our privacy notice. Please ensure that the referee is aware of this.
Thank you very much for your referral.
Acacia Family Support
If you live in Birmingham and need help?
If you need help or support or have any questions please call. 0121 301 5990
or click here to email us
If you live outside of Birmingham and need help?
If you need help or support please visit the Hearts and Minds website.