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Samaritans Referral

Referral using attached form

  • We simply require their preferred name, and telephone number
  • Please highlight on the form each day when you would like us to call, and circle one of the boxes to show the time when we should ring – e.g. 7pm – 9 pm.
  • We cannot arrange an exact time, as depending on when out other calls end is when we can call them, but a two hour window is normally enough.
  • We do not require any other details about the person.
  • We will then phone the person you have referred for the period you request (usually once a day for a week), but that is up to you the referrer to specify.
  • We give callers the opportunity to talk about what is going on in their lives.
  • Our service is confidential and non-judgemental.

Samaritans services are provided by carefully selected and highly trained volunteers from our centre in Earlsdon, Coventry.

Our service is confidential however, we will contact you immediately should we have any concern about a patient’s level of suicidal intent.

If our concern arises as a result of a phone call outside your normal working hours, we will inform the Crisis Team. This is a rare occurrence, however, we are committing to contact you should we believe that the referred person is intending to take their own life before we are next due to call them, or if we believe someone else could potentially be harmed because of what we have heard.

If we are going to do this, we will tell the referred person before we get in touch with you, or the Crisis team, it is then your responsibility to get in touch with the referred person.

With this exception anything the patient tells us will remain confidential, and we will not be able to tell you about anything they say to us, unless they specially authorise us to do so, or we are issued with a court order.

We ask you to make the person who you are referring aware of the workings of this scheme, and that you are referring them to us through this method, so they have given consent for the referral.

Please note our conversation is led by the referred person, and they could choose to not answer, or end their referral before the duration you have agreed with them. Alternatively, they may develop the confidence to phone us directly when they need support – as the great thing about the Samaritans service is someone is there 24 hours a day, 365 days a year, for when anyone regardless of age are really struggling.

If we have been able to speak to the person, we will then continue to try to make calls each day for the period you have specified. If we have not been able to get hold of them after attempts for two days, we will let you know and you can decide if you want to re refer them to us for a further seven days.

After the initial referral period, we hope that the patient will feel confident enough to ring us themselves if they need our support in the future, so they are more in control.

If they choose to ring us in this way, we will treat them in the same manner as any other caller. We will not therefore inform you of any calls they made.


We have set up a direct printing capability now for our referrals. Please complete the form as follows and send to: coventrysams-referrals@print.epsonconnect.com

Please note once sent your referral automatically prints out in our Coventry branch operations room, so as soon as someone is free they will pick it up.

You will receive an automatic email confirmation that your emailed referral has successfully been printed. If for any reason your referral does not print out, the system will automatically notify you, and you can try again.

If you want to email about something Samaritan related other than sending a referral form please email: outreach@coventrysamaritans.co.uk


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