Buckinghamshire Referral Form

Welcome to our online referral portal. If you need support with your referral, or have any questions, please call Freephone 0808 164 1810 (lines open Monday-Friday, 9am-5:30pm).

Who are you making a referral for?

Please confirm you have the appropriate authority and consent to share the clients details with us for the purposes of providing them a support service. You must have this before you continue.

To confirm, please click the below button.

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.

Have youthey ever been referred to P3 or another Buckinghamshire Housing Related Support service before?

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

Do any of the following apply?

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

Select yourtheir current local authority area.

Or

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

YourTheir Current Address

Our service is for Adults aged 16 and over.

Please confirm the age range of the person you wish to referyour age range.

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 all options that apply to yourtheir circumstances.

None of the above

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.

Referrer Details

Risks:

 

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.

YourTheir Details

YourTheir date of birth

Please enter in the boxes below

What is yourtheir best contact? Please provide one or more of the requested contact details:

Which is yourtheir preferred contact method?

Contact Time – when is the best time to contact youthem?

Are you happy for us to leave a voicemail?

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.

YourTheir accommodation status:

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.

Preferred Language

Do theyyou have any communication 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 any other circumstances that currently apply

Please note, P3 will never exclude you based on the info you provide here.

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

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

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.

If we are unable to contact youthe individual being referred directly, we can get in touch with a nominated secondary contact

Can we contact this person if we are unable to reach the individualyou directly?

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

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.

Feedback

Please rate your experience of this referral process

To what extent do you feel that this referral portal was easy to use?

Do you have any further comments or suggestions about our referral process?

 

Trouble using this portal? Click here

Colour Scheme: