Buckinghamshire Referral Form

You are making a referral to P3’s community housing support service for residents of Buckinghamshire. We provide support for people who may be at risk of losing their homes or accommodation, including providing advice and information on maintaining tenancies, tackling debt and staying independent. If you need support, or would like to refer someone, then please complete this online referral system. If you need support with your referral, or have any questions, please call Freephone 0808 164 1810 (lines open Monday-Friday, 9am-5pm).

Who are you making a referral for?

We use this information to ensure our service is right for your circumstances.

Are theyyou currently accomodated within Buckinghamshire?

We use your date of birth to confirm you meet the minimum age requirements for this service.

Are theyyou aged 16 years or over

Please enter theiryour date of birth in the box below

Not Sure?

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.

Please select one or more that apply?

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.

Please briefly explain the main reason(s) you feel support is needed:

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 being referred 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 your organisation details to monitor the sources of our referrals and to help us contact you if we need to.

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

Referrer Details

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

We use your contact details to contact you directly about your support.

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

Your Details

How should we contact you? Please provide one or more of the requested contact details:

Your address/current residence

We use telephone and/or email address details to contact the client directly about their support.

We use address information to ensure we can locate the client when providing support, and to verify their residential status in Buckinghamshire.

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

Client Details

How should we contact the client? Please provide one or more of the requested contact details:

Their address / current residence

Do theyyou have any accessibility needs?

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.

Their CircumstancesYour circumstances

Please select all circumstances that currently apply

We use this (optional) information 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.

Are there any other organisations or professionals involved in supporting the individualyou?

Data Consent

If a different local service is identified as being more suitable for your housing needs or support requirements, P3 will automatically transfer your referral to them on your behalf. Please click the accept button below to provide us with your permission to do this. If you are submitting a referral on behalf of somebody else, please click the accept button below to confirm they give their permission.