Views External

If you are referring a client internally (reception, mindline, counselling) to the Greenwich Peer Support Service, please complete this form.

Please note that fields with a red * are compulsory and must be completed to be able to submit this form

Identity

Forename

Surname

DateOfBirth

Address

Borough

Bromley Lewisham Greenwich Other

Contact

Telephone

Mobile

Email address. If client does not have an email, use peersupportgreenwich@blgmind.org.uk

Emergency Contact Details

Service communication preferences?

Service Related Information

Risk Assessment

Please outline why the person you are referring needs support required. Please share relevant information about support needs including any risk information (risk to self, risk to others, risk from others, risk within group work)

Additional Information

Has there been a referral made or are they currently on a waiting list to access Greenwich Mindline, Greenwich Counselling Services or attend therapeutic groups? If yes, please specify