Southwark Wellbeing Hub GENERAL REFERRAL FORM FOR SOCIAL AND COMMUNITY SUPPORT AS A RESULT OF MENTAL HEALTH ISSUES Referral Date Service/Team Referrers Name Job Title Phone Email Address Post Code PERSON BEING REFERRED’S BASIC INFORMATION Name D.O.B Address Post Code NHS Number Phone Email Immigration Status Communication GP Details Needs SIGNPOSTING OR LOWER SUPPORT NEED At The Wellbeing Hub we can provide signposting or light touch support helping people access and engage with different opportunities in the community. Please indicate below which areas are applicable for the person you are referring below and provide more information about why this is important. Referrals may not be accepted if sufficient supporting information is not provided. DWP Benefits Healthy Lifestyle: e.g. nutrition, physical activity. Making social contacts, meeting Finances or Debt people, reduce loneliness. Engaging with community, helpful Substance misuse activities, to reduce isolation. Coping strategies or meeting other people Accessing volunteering, employment, education or going through similar issues training. If checked boxes above, provide more information here.
GENERAL Southwark Wellbeing Hub REFERRAL FORM FOR SOCIAL AND COMMUNITY SUPPORT AS A RESULT OF MENTAL HEALTH ISSUES Referral Date Service/Team Referrers Name Job Title Phone Email Address Post Code PERSON BEING REFERRED’S BASIC INFORMATION Name D.O.B Address Post Code NHS Number Phone Email Immigration Status GP Details Communication Needs SIGNPOSTING OR LOWER SUPPORT NEED At The Wellbeing Hub we can provide signposting or light touch support helping people access and engage with different opportunities in the community. Please indicate below which areas are applicable for the person you are referring below and provide more information about why this is important. Referrals may not be accepted if sufficient supporting information is not provided. DWP Benefits Healthy Lifestyle: e.g. nutrition, physical activity. Making social contacts, meeting people, reduce loneliness. Finances or Debt Engaging with community, helpful activities, to reduce isolation. Substance misuse Coping strategies or meeting other people going through similar issues Accessing volunteering, employment, education or training. If checked boxes above, provide more information here.