Agency Referrals

Referring agencies…

We take referrals of new clients directly from the following HIV support agencies and organisations:

BSUH
Community HIV Specialist Team – South Downs Health NHS
East Sussex PCT
Mind OUT
St.Peter’s House Project
Sussex Beacon
Sussex Partnership
Terrence Higgins Trust
West Sussex PCT

Referrals –Referring Organisations Information

Thank you for taking the time to refer your client to us.

Please complete the form below, which will be processed securely using an SSL certificate – indicated by the ‘padlock’ symbol shown on this page of your browser.
We are able to authenticate that this form has been sent by your organisation, and that the client is therefore eligible to use our service.

We only need the minimum of client’s information on the referral form which we will corroborate with the client when they first use the service.

Please would you ensure all fields below are completed, using the drop down menu to indicate your organisation.

Referring Organisation*

Referring Worker:

Workers Email Address

Client's First Name

Client's Surname Initial:

Client's Date of Birth:

Does the person referred have any special requirement around access? If so please briefly describe. Note we may discuss these issues with the client

MENU