MENU
MENU
How We Help
Gloucestershire Services
Hertfordshire Services
Oxfordshire Services
Guideposts Information & Support
Resources
Wellbeing
Managing stress and anxiety
Wellbeing during COVID-19
Sleep
Mindfulness
Peer Support
Support lines
Digital tools
Stay Connected
Getting online
Making connections from home
STAY INDEPENDENT
Getting Out & About-Transport
Getting Out & About-Mobility Equipment
Getting & Maintaining Equipment
Gardening, Cleaning & DIY
Who We Are
About Us
Blog
Our Responsibilities
Our Trustees
Contact
Tell Us Your Views
Opportunities
Contact Us
Support Us
Donate Now
Stay Connected – Make A Referral
Client details
Title
First name
*
Surname
*
Date of birth
Address (incl postcode)
Home phone
Mobile phone
Email address
Gender
Ethnicity
Health issues
Living alone?
Yes
No
Other support services involved
Is an interpreter required? If so, please specify which language:
Is the client aware of the referral?
Yes
No
Has consent been obtained for client’s personal details to be passed on to the Guideposts Information Service?
Yes
No
Does the client pose any risk of harm to themselves?
Yes
No
Does the client pose any risk of harm to others?
Yes
No
Are there any other risks we should be aware of?
Yes
No
Outline any specific risks identified
In what areas does the client want help?
Physical health
Lifestyle change
Self-care -management of long-term health condition
Mental health and wellbeing
Accessing work, training, and volunteering
Practical help – Shopping,cooking, cleaning
Social isolation or loneliness
Carer support
Leisure activities and interest groups
Benefits, finance, and social care advice
Life events -bereavement childbirth or retirement
Other
What outcome does the client want from the referral?
Additional information you think we need to know e.g. housing, finance, communication (hearing or speech difficulties)
GP details
GP Surgery
Postcode
GP email address
Please complete this section if referrer is NOT the client’s GP
Referrer's name
Service type
Address
Postcode
Job title
Phone number
Email address
Finally...
Best time to contact client
