Referral Form

This form is for CAERPHILLY referrals only. For Newport please use the Newport gateway only. For all other enquiries please contact us via our e-mail address info@holistic-hoarding.co.uk Please fill out the referral form with as much detail as possible For Private consultations please contact us directly via email.

Details of the Referrer

Referrer's Name
DD slash MM slash YYYY

Details of the person being referred

Name
Address
DD slash MM slash YYYY
Gender

Assessment Information

(please use this space to outline the current situation at the property with as much detail as possible)
(eg, Clean and Clear, counselling).
(eg, risk of eviction or ongoing Child Protection Proceedings).
(eg, does the individual wish to move?)

Thank you for taking the time to provide this information.

A full assessment will be carried out, and you will be updated of all outcomes regarding this. Holistic Hoarding will work on a needs-led basis with 10 individuals at a time – referrals will be prioritized according to urgency (in particular, those threatened with eviction or where children reside at the home) and a waiting list system will operate for all other cases.

 

To register for support from Holistic Hoarding, we ask for consent to hold and process personal and confidential information about you.  This information will be held on a digital database in accordance with data protection and will enable the organization to assess suitability of the referral and for us to best meet your needs.  Where appropriate, we may need to share this information with our partner organisations on a need-to-know basis to help us manage risk and to ensure that we are delivering the highest level of support possible.  The information shared may also be used to inform future planning of the service, and your privacy will be fully protected and all identifying information removed in these cases.