Support & Wellbeing Information Service Harrow (Swish) Referral Form

Support & Wellbeing Information Service Harrow (SWiSH) Referral Form

Eligibility Checklist Ordinarily resident of Harrow 18 years or over

Client Contact & Personal Details Full Name Title Address Postcode Landline Mobile Date of birth Male Female Email

Access Needs Interpreter needed Language(s): Disability access needs

What information or advice is needed

Client Needs Autistic spectrum Mental health Carer Older person (60 years old +) Dementia Physical disability Learning disability Sensory impairment

Response time requested Crisis Urgent Non-urgent (today) (Next day) (3-5 working days)

Type of service requested Phone Email Face-to-face

Client Risk Assessment High risk Medium risk Low risk Please provide details - Medium to High risk

Referrer – Contact Details

Staff name Agency Phone Email Client consent given to share this information

How to use this form is explained on page 2.

FOR OFFICE USE: Referral ID number 1 About the Support & Wellbeing Information Service Harrow (SWiSH) Harrow Community Action (HCA) consortium is providing this service with 5 local charities: Age UK Harrow, HAD, Harrow Carers, Harrow Mencap and Mind in Harrow. This service has been commissioned by Harrow Council to provide a local Care Act 2014 Information & Advice Service.

Who our service is for  For anyone in Harrow 18 years and over who wants information or advice about local support services for and ways to keep safe and well.  As well as people looking for help for themselves, the service is open to carers and staff in local organisations.

What the service offers We can offer information or advice about a wide range of local services, including: where to go to keep fit and well, manage finances, join social groups, look for work, start a course, access help with housing or welfare benefits or apply for a personal budget.

Our service does not offer financial advice, legal advice, advocacy 1:1 case support for welfare benefits and housing, but we can provide information about where to find this help. Please contact our service to find out more.

How to use the referral form Please ensure the ‘Client consent given to share this information’ box is ticked before sending to the service. Thank you.

For referrals as a general enquiry, please send the referral form to Mind in Harrow: Mind in Harrow, First Floor, 132 – 134 College Rd, Harrow HA1 1BQ Email: [email protected] Tel: 020 8426 0929

If you would prefer send your referral one of our specialist information & advice services directly, their contact details are provided below:

For people who are 60 years and over and people with dementia Age UK Harrow, 3rd Floor, Premier House, 1 Canning Road, Wealdstone HA3 7TS Email: [email protected] Tel: 020 8861 7980

For people with disabilities Harrow Association of Disabled People (HAD), The Wealdstone Centre, 38-40 High Street, Wealdstone, HA3 7AE Email: [email protected] Tel: 020 8861 9920

For carers Harrow Carers, 376-378 Pinner Road, Harrow HA2 6DZ Email: [email protected] Tel: 0208 868 5224

For people with learning disabilities and/or autism and their carers Harrow Mencap, 3 Jardine House, Harrovian Business Village, Bessborough Road, Harrow HA1 3EX Email: [email protected] Tel: 0208 423 7382

For people with mental health problems Mind in Harrow, 1st Floor, 132-134 College Road, Harrow HA1 1BQ Email: [email protected] Tel: 020 8426 0929

FOR OFFICE USE: Referral ID number 2