Is there any support in particular you are requesting? b) Foster support network opportunity to develop a new companion animal relationship. – (This might involve elderly animal rehoming, supported fostering, companion animals for senior ‘senior people’ and associated services). ☐ ‘maintenance’ Other e.g. other match-up service - please specify what is needed: – Please confirm a contact name in case of emergency/next of kin: Name: Address: Contact number: Relationship to client: GP Practice: Email: Named contact at GP surgery: Tel number: Practice address and post code: Is there any regular social care involvement already in place at the home? E.g. Social services, Voluntary organisations, private providers etc. If Yes please outline service and frequency. Additional relevant information. (e.g. Medical conditions/Risks relating to the client, companion animal or premises): Name and contact details for partner’ submitting this application: ‘referral Signature of client seeking service: Date: When completed please email to: or send to: . c/o Animal Aid, Elmwood Farm, , Huncote, Leicestershire. LE9 3LE. Tel: 01455 888257. What happens next?: We aim to get back in touch with you as soon as possible to discuss how we can help. Each client and their companion animal will also be risk assessed by the pilot co-ordinator. If assessed as suitable for the scheme a tailored programme of support for an agreed length will be provided and the client will be to agree to this (see outline below). At the end of the intervention the pilot co-ordinator will evaluate the input. *This service is provided free of charge with the exception of boarding & emergency animal care which will incur a cost.
Is there any support in particular you are requesting? b) Foster support network – opportunity to develop a new companion animal relationship. (This might involve elderly animal rehoming, supported fostering, ‘senior companion animals for senior people’ and associated ‘maintenance’ services). ☐ Other – e.g. other match-up service - please specify what is needed: Please confirm a contact name in case of emergency/next of kin: Name: Address: Contact number: Relationship to client: GP Practice: Email: Named contact at GP surgery: Tel number: Practice address and post code: Is there any regular social care involvement already in place at the home? E.g. Social services, Voluntary organisations, private providers etc. If Yes please outline service and frequency. Additional relevant information. (e.g. Medical conditions/Risks relating to the client, companion animal or premises): Name and contact details for ‘referral partner’ submitting this application: Signature of client seeking service: Date: When completed please email to: or send to: . c/o Animal Aid, Elmwood Farm, , Huncote, Leicestershire. LE9 3LE. Tel: 01455 888257. What happens next?: We aim to get back in touch with you as soon as possible to discuss how we can help. Each client and their companion animal will also be risk assessed by the pilot co-ordinator. If assessed as suitable for the scheme a tailored programme of support for an agreed length will be provided and the client will be to agree to this (see outline below). At the end of the intervention the pilot co-ordinator will evaluate the input. *This service is provided free of charge with the exception of boarding & emergency animal care which will incur a cost.
CPSSReferralForm.docx