Self Referral Form

Pupil Request for Support/Advice

Please complete this form if you think you'd benefit from talking to one of our support team about an issue you may have with your own health and well-being. Give a brief descption of what the issue is about (you do not need to put full details) and one of our support team will be in contact you.


The Woodlands, Hartshill, Nuneaton, Warwickshire, CV10 0SZ, 0247 639 2272
Email: admin@mdjs.co.uk