Supporting families who have suffered the loss of a child or have a child living with medical complexities

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Supporting families who have suffered the loss of a child or have a child living with medical complexities

Events

Donate

Home
About Us
Family Support
Get Involved
Contact Us
News
Shop

Referral Form

Please fill in the form below. Our friendly family support team work Wednesday – Saturday so once you have submitted we will be in touch within 5 working days to discuss any further information and next steps.

Contact Form Demo (#4)

I am a

Parent

Professional

Seeking:

Support for a complexly poorly child

Support for child loss

I'm making this referral for:

Myself

On behalf of someone else

First Name

Last Name

Subject

Your Message

The personal information you provide will be kept secure and only used by Reuben’s Retreat personnel to support the delivery of our charitable activities. Reuben’s Retreat may be required to share some of the non-identifying information where relevant and appropriate to the bodies responsible for regulating and/or funding Reuben’s Retreat. You can ask for your personal information to be removed from our records at any time however there are limitations on this, such as where we must retain the data for legal or regulatory purposes.

Consent to Receive:

I am a: I am a: Parent Professional

Seeking: Seeking: Support for a complexly poorly child Support for child loss

I'm making this referral for: I'm making this referral for: Myself On behalf of someone else

Full Name

Email Address

Phone Number

If you are a professional making a referral on behalf of somebody else, please add more details below:

How did you find out about Reuben's Retreat? How did you find out about Reuben's Retreat? Google/ Internet Search Social Media From a magazine or publication From a Doctor From a health worker or professional Other

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Thank you!

Reuben’s Retreat

The Lodge at Reuben’s, Park Crescent, Glossop, SK13 7BQ

Suite 4, St Michaels Court, Stamford Street Central, Ashton-under-Lyne, OL6 6XN

Tel: 01457 680 023

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Reuben’s Retreat is a registered charity in England and Wales (1150436) I Registered company (08292532)

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