This referral has NOT been sent yet. You will be redirected to the listing's external referral form. Please complete the referral form there to submit the referral confirm Details Social Prescribing - Colne Union PCN. WAITING LIST IN ACTION! by Hillingdon - Colne Union PCN I am signing up myself I am referring someone else Service access criteria Tick to confirm you have checked the service access criteria "Non-medical and not an emergency or urgent service! For 18+ without complex mental health needs. Unable to accept referrals for patients who are currently under the care of the CCT, HIU or the Wellbeing Support Officers / Advisors." Your Details Email Email is invalid We already have an account with this email. Please log in. Password Reset my password Log in First name Last name Your relationship to the person Organisation name Who are you referring? First name Last name Known as Date of birth Email Don't know / client doesn't have an email address Phone Address Line 1 Address Line 2 Town/City Postcode GP surgery NHS number Ethnicity SelectEnglish, Welsh, Scottish, Northern Irish or British Irish Gypsy or Irish Traveller Any other White backgroundWhite and Black Caribbean White and Black African White and Asian Any other Mixed or Multiple ethnic backgroundIndian Pakistani Bangladeshi Chinese Any other Asian backgroundAfrican Caribbean Any other Black, African or Caribbean backgroundArab Any other ethnic groupPrefer not to say Gender SelectFemale Male Transgender female Transgender male Non-binary Intersex Not specified Not known Other Additional referral details What are the reasons for this referral? Sedentary lifestyle Finances Caring responsibilities Loneliness/isolation Employment Food Poverty Substance misuse Transport Legal advice Day-to-day helping hand Bereavement Stress Training and Education Crown Lodge Accommodation Novotel This field is required. Should the service provider be aware of any additional needs? Blind/partially blind Memory problem Hearing loss Housebound Does not speak English Poor mobility Learning and communication needs Physical disability Frail Other: Please share some brief details regarding this referral Please do not write "see consultation notes" and kindly provide details: If the patient does not speak English, please provide their preferred language. Is the patient already being supported by any of the below services? CMHT H4ALL ARCH Adult Social Care – Patient has a Social Worker CCT – If the pt is under the CCT please do NOT refer to Social Prescribing and speak to the CCT WSA. Patient is not under any other services Other: This field is required. I understand that Social Prescribing Service is a non urgent, non-medical, signposting and referral service. That will provide me details of services that I can access to support my social / practical / well-being needs Please confirm that the patient is over 18 years old Yes This field is required. Please confirm if there are any safeguarding concerns with this patient. If yes, please give details to help keep patients and staff safe Confirmation and consent Tick to confirm you have gained consent to share this information with the service provider, your organisation and Joy Tick to confirm the service provider can directly contact the client Would you like to create an account? Make referrals faster next time you use Joy. Registered users can message service providers, submit reviews and track the progress of their referrals online. Password Weak password! Use at least 8 characters Use upper and lowercase characters (a-z) Use 1 or more numbers (0-9) Confirm password Please enter the same value again. required Submit Email: Password: Email
