Buckinghamshire Referral Form

If you have previously received support from us, we can review previous records (only with your consent) to ensure we can pick-up from previous support provided.

This helps us tailor our support offer to your circumstances and history.

We use this information to ensure the correct provision is allocated to you and to confirm your eligibility for support.

We use your address as the primary place to visit you to provide support and/or to send relevant correspondence if required.

Our service is for Adults aged 16 and over.

We use this information to establish how best we can help you, and to ensure you meet the eligibility requirements to receive support from our service. This information is also used to allow us to prioritise your case based on the information and circumstances you provide.

We use your name in order to address you when responding to or contacting you about your referral.

We use your relationship to the individual information to monitor the sources of our referrals and to ensure we are aware of you as a key contact for the individual being referred.

We use organisation information to monitor the sources of our referrals and to help us contact you if we need to.

We use contact information to keep you informed about your referral, and/or to contact you to clarify or discuss any information you may have provided.

We use risk information to ensure our staff are fully aware of any circumstances that may require us to take appropriate steps to ensure the safety of our employees.

We use your name in order to address you when discussing your referral and any future correspondence or communication in relation to your support

Our service is for Adults aged 25 or older. We use date of birth information to validate your eligibility for this service.

We use contact information to make contact about the assessment and support.

We use accomodation status information to establish how best we can help you.

We use address and location information to ensure we can locate you when providing support, and to verify your residential status in Derbyshire.

We use language preference information to ensure we communicate with you in the correct language, and that you understand any documentation or conversations that we may have

We use accessibility needs information to ensure we can adapt our service, support, and contact arrangements to fit any accessibility requirements you may have.

We use this information to allow us to understand what it is you need help with, and to ensure we can correctly prioritise you if a waiting list is currently in operation.

We use this information to allow us to understand the reasons behind the need for support from our service.

We use next of kin information as part of our safeguarding procedures, if have concerns or in the event of an emergency we may be required to reach out to a next of kin.

We use the (optional) information about other organisations involvement to make contact with professionals with whom you are already involved with, to ensure we compliment any existing support you may be receiving and to prevent duplication or repetition.