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Services & Organisations Referral Form

Services & Organisations Referral Form

Refer to a Social Prescriber

We do our best to contact individuals in need of support within a reasonable time, and where there is high demand for Social Prescribing assistance you’ll be informed of an estimated waiting time.

Note that this is not an emergency service.

If you wish to seek specific support of local services yourself, the following online resources are available:

Tower Hamlets Connect

Tower Hamlets Local Offer

Self Help - THCAN

Where you see an asterisk (*) this indicates a required field.

Client’s Full Name *

Clients Date of Birth *

Home Postcode *

Client’s GP Practice *

Client’s Contact Number (if providing a guardian’s contact number, please clarify their relationship to the client) *

What does the client need support with (include relevant background information for context)? *

Does the client require an interpreter? (please state the language) *

Does the client pose any risk being seen alone? *