Gloucestershire Community Based Support

Welcome to our online referral portal. If you need support with your referral, or have any questions, please call:
0808 168 2443 for Stroud, Cheltenham, and Cotswolds
or 0300 365 2002 for Gloucester, Forest of Dean, and Tewkesbury.
Lines are open Monday-Friday, 9am-5pm.

This helps us identify the right support for your circumstances.

Please select your area.

Data consent

The Community Based Support service in Gloucester, Tewkesbury, and Forest of Dean, is delivered by CCP (ccp.org.uk). You can read the Privacy Policy here.
You can still continue with your referral using this portal, this is just to let you know that CCP will be your support providers.

Who are you making a referral for?

Please confirm you have the appropriate authority and consent to share the clients details with us for the purposes of providing them a support service. You must have this before you continue.

To confirm, please click the below button.

If you have previously received support from us, we can review previous records (only with your consent) to ensure we can pick-up from previous support provided.

Have youthey ever been referred to a Housing Related Support service before?

We use your name in order to address you when responding to or contacting you about your referral.

We use your relationship to the individual information to monitor the sources of our referrals and to ensure we are aware of you as a key contact for the individual being referred.

We use organisation information to monitor the sources of our referrals and to help us contact you if we need to.

We use contact information to keep you informed about your referral, and/or to contact you to clarify or discuss any information you may have provided.

We use risk information to ensure our staff are fully aware of any circumstances that may require us to take appropriate steps to ensure the safety of our employees.

We use your address information to keep you informed about your referral, and/or to contact you to clarify or discuss any information you may have provided.

Referrer Details

We use this information to ensure our staff are fully aware of any circumstances that may require us to take appropriate steps to ensure the safety of our employees.

We’ll list a number of circumstances and risks that its important we’re aware of.

Please rate using the drop-down boxes to what extent you feel these risks apply to the person you’re referring

Risks to Others (e.g. Physical or sexual abuse of others, violent attitudes or aggressive behaviour, access to weapons, current and historical triggers)

Risks from Others (e.g. domestic violence, child / sexual, physical, emotional abuse, bullying, racial harassment)

General Wellbeing Factors (e.g. depression, mental health, current and historical factors, medication, trigger factors, diagnosis, counselling)

Addiction Issues (e.g. Substance misuse, gambling, sex, history, trigger factors, counselling, date of last episode)

We use your name in order to address you when discussing your referral and any future correspondence or communication in relation to your support

We use date of birth information to ensure you are accessing the most appropriate service for your needs and circumstances.

We use contact information to make contact about the assessment and support. By adding your contact details, you consent to us using them for the purposes of processing your referral and/or providing you with a support package.

We’ll do our best to make sure we contact you using the most convenient method and at the most convenient time

If you’re happy for us to leave a voicemail on the numbers you have provided, please provide your consent. If you don’t, we’ll still call you – but we won’t leave a voicemail.

YourTheir Details

YourTheir date of birth

Please enter in the boxes below

What is yourtheir best contact? Please provide one or more of the requested contact details:

Which is yourtheir preferred contact method?

Contact Time – when is the best time to contact youthem?

Are you happy for us to leave a voicemail?

We use your address as the primary place to visit you to provide support and/or to send relevant correspondence if required.

YourTheir Current Address

How long have yourthey been at this address?

If anyone else lives at this address, please provide some information. (i.e. Partner, Children).

YourTheir accommodation status:

Have you recently received notice of eviction which could result in homelessness?

We may be able to provide a faster response. If you live in Stroud, Cheltenham, or Cotswolds, contact P3 on 0808 168 2443. If you live in Gloucester, Forest of Dean, or Tewkesbury, contact CCP on 0300 365 2002. You can still continue with your referral here.

Is there an immediate risk of homelessness (within 7 days)?

We use this information to ensure we can adapt our service, support, and contact arrangements to fit any accessibility requirements you may have.

We ask about financial issues relating to arrears or debt so we can then make sure our support plan is designed to help resolve any related issues and help you achieve sustainable finances.

Do theyyou have any communication needs?

We use income information so our staff can ensure you’re receiving all of the financial support you’re entitled to. It also allows us to support you in sustainable budgeting.

TheirYour Income

Please select all financial support currently being received:

Can you provide (or estimate) the total monthly current household income?

Does anyone in the household have outstanding rent arrears?

Does anyone in the household have any other debts?

TheirYour Circumstances

How can we help? Please let us know the current situation and circumstances, and what support is required from our service.

We use next of kin information as part of our safeguarding procedures, if have concerns or in the event of an emergency we may be required to reach out to a next of kin.

We use the (optional) information about other organisations involvement to make contact with professionals with whom you are already involved with, to ensure we compliment any existing support you may be receiving and to prevent duplication or repetition.

Others involved

If we are unable to contact youthe individual being referred directly, we can get in touch with a nominated secondary contact

Can we contact this person if we are unable to reach the individualyou directly?

Are there any other organisations or professionals involved in supporting the personyou?

Data Consent

Please read and accept your understanding of our Privacy Statement which can be found here.

Feedback

Please rate your experience of this referral process

To what extent do you feel that this referral portal was easy to use?

Do you have any further comments or suggestions about our referral process?

 

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