07398 395425 info@goddessliving.co.uk

Referral Form

Service User Details

Referral Form

Service User Details

External Agency Contact Information

Our multi-agency approach enables us to confirm that any individual offered Goddess Living
supported accommodation is correct and appropriate for them. Please can you name any other
agencies that is involved with the individual.

If No please give detail of the individuals representative below

Declaration

THIS MUST BE SIGNED BY PERSON WHO IS BEING REFFERED OR AN EMAIL ATTCAHED
FROM THEM CONFIMING THEY CONSENT TO THE BELOW

‘I give my permission for enquiries to be made based on the information I have provided to establish accommodation suitability and my support needs. I give my permission for Goddess Living CIC to carry out all necessary checks for the purpose of this application which may include safeguarding related enquiries and previous landlords’ references.

I declare that I can legally reside in the UK and I will provide the company with proof of identification
upon my successful application.’

Diagnosis / Mental Health / Physical conditions/ Known Risk Factors/ Current Medication/
Incidents in the last 6 months.

Please provide as much information as possible. Include any support in place, restrictions, ADL skills, medication, and CPN Level.

Office use: 

Eligibility Criteria:

  • Female aged 18 Plus
  • Background information if available e.g. Care Plan, OT Report, etc.
  • Service User is prepared to engage with support and engage in other services
    provided

Making a referral:

PLEASE NOTE: our properties are not manned on site 24/7 however staff visit our properties
at least twice a week to deliver support.

We accept individuals who may be experiencing mental health problems, limited capability for work, No Fixed Abode, Alcohol and substance misuse, at risk of homelessness, stepdown from psychiatric hospital, care homes, history of some low risk challenging behavior.