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What is your name?
What are your contact details? Mob:Email: Other:
What is the safest way to contact you and when?
Would you like us to text you first to arrange a time to talk?
Please give us a brief description of any issues you may need support
with.
Do you need our support?We can offer you free 1-2-1 support if you are struggling
with your mental health and emotional well-being in relation to your sexuality and/or gender identity.
Please complete the information below and we will be in touch.
Are you questioning your gender/sexuality?
Are you aged between 12-25?
Are you LGBTQ+?
Are you struggling?
Please return referral forms via post or email:
Positive Identities Service, Trinity House, Blackwall, Halifax, HX12QR
Email: [email protected]/ [email protected]