Menu

We accept referrals from professionals and other organisations and people can self refer by using the online form below or by calling us direct on 0115 9787161.

Referrals

You can download our referral form as a Word Document by Clicking the documents below. you can then post this form to

Explore Family
200 Mansfield Road
Nottingham
NG3 1HX

or
Email to Notts.admin@lifeline.org.uk

Downloads

Explore Family Referral Form WF

Online Referral

Name (required)

Email (required)

Street Address

Address Line 2

City

Post Code

Phone Number (required)

Date of Birth (required)

Gender (required)

Ethnicity (required)

Substance Impacted By

Tell Us About Your Situation